AMA Journal of Ethics®

Illuminating the art of medicine

Journal of Ethics Header

AMA Journal of Ethics®

Illuminating the art of medicine

Virtual Mentor. January 2005, Volume 7, Number 1.

Module 2

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Case 2.3 Surrogate Decision Making—Mrs. Douglas's Choice of Treatment for Her Husband

Related topic: Advance directives

Opinion 8.081, "Surrogate Decision-Making" also recommends that:

Physicians should encourage their patients to document their treatment preferences or to appoint a health care proxy with whom they can discuss their values regarding health care and treatment. Because documented advanced directives are often not available in emergency situations, physicians should emphasize to patients the importance of discussing treatment preferences with individuals who are likely to act as their surrogates.

Dr. Kim should have recommended either an advance directive or that Mr. Douglas discuss his preferences with Mrs. Douglas. He might also have raised the possibility of a DNR, should Mr. Douglas be incapacitated. This obligation is especially poignant in this case because Mr. Douglas had a substantial risk of presenting in an emergency situation in which he was incapacitated. Had Dr. Kim discussed the possibility of this kind of situation with Mr. Douglas during their first discussion, Mr. Douglas may have given clear indication about his preferences for treatment.

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