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

Publication ,  Journal Article
Rosoff, PM; Leong, KM
Published in: J Law Med Ethics
2015

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.

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Published In

J Law Med Ethics

DOI

EISSN

1748-720X

Publication Date

2015

Volume

43

Issue

4

Start / End Page

857 / 877

Location

England

Related Subject Headings

  • United States
  • Proxy
  • Physicians
  • Physician-Patient Relations
  • Patient Preference
  • Mental Competency
  • Humans
  • Bioethical Issues
  • Applied Ethics
  • 5001 Applied ethics
 

Citation

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ICMJE
MLA
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Rosoff, P. M., & Leong, K. M. (2015). An Ethical and Legal Framework for Physicians as Surrogate Decision-Makers for Their Patients. J Law Med Ethics, 43(4), 857–877. https://doi.org/10.1111/jlme.12325
Rosoff, Philip M., and Kelly M. Leong. “An Ethical and Legal Framework for Physicians as Surrogate Decision-Makers for Their Patients.J Law Med Ethics 43, no. 4 (2015): 857–77. https://doi.org/10.1111/jlme.12325.
Rosoff, Philip M., and Kelly M. Leong. “An Ethical and Legal Framework for Physicians as Surrogate Decision-Makers for Their Patients.J Law Med Ethics, vol. 43, no. 4, 2015, pp. 857–77. Pubmed, doi:10.1111/jlme.12325.
Journal cover image

Published In

J Law Med Ethics

DOI

EISSN

1748-720X

Publication Date

2015

Volume

43

Issue

4

Start / End Page

857 / 877

Location

England

Related Subject Headings

  • United States
  • Proxy
  • Physicians
  • Physician-Patient Relations
  • Patient Preference
  • Mental Competency
  • Humans
  • Bioethical Issues
  • Applied Ethics
  • 5001 Applied ethics