Perspectives

Dealing With Surrogate Conflict: A Student’s Perspective

Authors: Derek Su, MD, David A. Fleming, MD, MA

Abstract

Surrogate decision making is a standard arrangement for patients who are unable or unfit to make independent healthcare decisions. Ideally, the surrogate–patient relationship would be current and meaningful, and the participants in it would have recently discussed the patient’s values, preferences, and treatment goals. For patients who have not recently been able to make independent healthcare decisions, knowing what treatment they would desire often is impossible, and conflict many times is unavoidable.

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References

1. Arnold RM, Kellum J. Moral justifications for surrogate decision making in the intensive care unit: implications and limitations. Crit Care Med 2003;31(5 suppl):S347-S353.
2. Pellegrino ED. What the philosophy of medicine is. Theor Med Bioeth 1998;19:315-336.
3. Tunney RJ, Ziegler FV. Toward a psychology of surrogate decision making. Perspect Psychol Sci 2015;10:880-885.
4. Fleming DA, Sheppard VB, Mangan PA, et al. Caregiving at the end of life: perceptions of health care quality and quality of life among patients and caregivers. J Pain Symptom Manage 2006;31:407-420.
5. Fagerlin A, Ditto PH, Danks JH, et al. Projection in surrogate decisions about life-sustaining medical treatments. Health Psychol 2001;20:166-175.
6. Vig EK, Sudore RL, Berg KM, et al. Responding to surrogate requests that seem inconsistent with a patient’ living will. J Pain Symptom Manage 2011;32:777-782.
7. Danis M, Garrett J, Harris R, et al. Stability of choices about life-sustaining treatments. Ann Intern Med 1994;120:567-573.
8. Emanuel LL, Emanuel EJ, Stoeckle JD, et al. Advance directives. Stability of patients’
treatment choices. Arch Intern Med 1994;154:209-217.
9. Terry PB, Vettese M, Song J, et al. End-of-life decision making: when patients and surrogates disagree. J Clin Ethics 1999;10:286-293.
10. Puchalski CM, Zhong Z, Jacobs MM, et al. Patients who want their family and physician to make resuscitation decisions for them: observations from SUPPORT and HELP. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment. Hospitalized Elderly Longitudinal Project. J Am Geriatr Soc 2000;48( 5 suppl ):S84-S90.
11. Sehgal A, Galbraith A, Chesney M, et al. How strictly do dialysis patients want their advance directives followed? JAMA 1992;267:59-63.
12. Tunzi M. Advance care directives: realities and challenges in central California. J Clin Ethics 2011;22:239-248.
13. Sudore RL, Landefeld CS, Barnes DE, et al. An advance directive redesigned to meet the literacy level of most adults: a randomized trial. Patient Educ Couns 2007;69:165-195.
14. Ugalde A, O'Callaghan C, Byard C, et al. Does implementation matter if comprehension is lacking? A qualitative investigation into perceptions of advance care planning in people with cancer. Support Care Cancer 2018;26:3765-3771.
15. Sulmasy DP, Snyder L. Substituted interests and best judgments: an integrated model of surrogate decision making. JAMA 2010;304:1946-1947.
16. Phillips J, Wendler D. Clarifying substituted judgement: the endorsed life approach. J Med Ethics 2015;41:723-730.
17. Sulmasy DP, Sulmasy LS. On substituted arguments. J Med Ethics 2015;41:732-733.
18. Brudney D. Patients, doctors and the good life (for the patient). J Med Ethics 2015;41:733-735.
19. Chan HM. Whose decision? Whose practice? J Med Ethics 2015;41:735-736.
20. Dresser R. Substituted judgment in real life. J Med Ethics 2015;41:731-738.
21. Lynn J. Conflicts of interest in medical decision-making. J Am Geriatric Soc 1988;36:945-950.
22. Rhodes R, Holzman IR. The not unreasonable standard for assessment of surrogates and surrogate decisions. Theor Med Bioeth 2004;25:367-385.
23. Varma S, Wendler D. Medical decision making for patients without surrogates. Arch Intern Med 2007;167:1711-1715.
24. d'Aloja E, Pintor M, Paribello F, et al. Neither freedom nor autonomy without beneficence. Arch Intern Med 2008;168:548-549.
25. Fine RL. Keeping the patient at the center of patient- and family-centered care. J Pain Symptom Manage 2010;40:621-625.