An Ethical and Legal Framework for Physicians as Surrogate Decision-Makers for Their Patients.

Journal Article

In Western industrialized countries, it is well established that legally competent individuals may choose a surrogate healthcare decision-maker to represent their interests should they lose the capacity to do so themselves. There are few limitations on who they may select to fulfill this function. However, many jurisdictions place restrictions on or prohibit the patient's attending physician or other provider involved with an individual's care to serve in this role. Several authors have previously suggested that respect for the autonomy of patients requires that there be few (if any) constraints on whomever they may appoint as a proxy. In this essay we revisit this topic by first providing a survey of current state laws governing this activity. We then analyze the clinical and ethical circumstances in which potential difficulties could arise. We take a more nuanced and circumspect view of prior suggestions that patients should have virtually unfettered liberty to choose their healthcare proxies. We suggest a strategy to balance the freedom of patients' right to choose their surrogates with fiduciary duty of the state as regulator of medical practice. We identify six domains of possible concern with such relationships and suggest straightforward methods of mitigating their potential negative effects that could be plausibly be incorporated into physician practice.

Full Text

Duke Authors

Cited Authors

  • Rosoff, PM; Leong, KM

Published Date

  • January 2015

Published In

Volume / Issue

  • 43 / 4

Start / End Page

  • 857 - 877

PubMed ID

  • 26711423

Electronic International Standard Serial Number (EISSN)

  • 1748-720X

International Standard Serial Number (ISSN)

  • 1073-1105

Digital Object Identifier (DOI)

  • 10.1111/jlme.12325

Language

  • eng