Advance directives, substituted judgment, and the best-interest standard all have limitations that constrain their usefulness in making medical decisions for patients who cannot choose for themselves.
Paula Tironi, JD, LLM and Monique M. Karaganis, MD
While parents often have legal authority to make decisions regarding pediatric palliative care, federal and state statutory and case laws, like CAPTA, impose significant restrictions on that authority.
Advance directives do not always resolve questions about the best care for patients who no longer have decision-making capacity; physicians and patient surrogates can take alternative approaches to arrive at the best care decision.
The Internet has changed the patient-physician relationship but may actually help that relationship become more equally balanced in terms of information flow.
Three reports considered by the Council on Ethical and Judicial Affairs are described, along with the process for revising the AMA's Code of Medical Ethics and trivia about contraceptive use.