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.
The practice of banking sperm from adolescents about to undergo chemotherapy is not universal, which lends support to the argument that parental consent be required for the intervention.
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 profession of medicine is duty-bound to further the best interests of the public. If evidence suggests that discrimination based on sexual orientation or denial of civil marriage to GLBT couples has adverse effects on their health, physicians must oppose such practices, regardless of their personal biases.
Kym Ahrens, MD, MPH, F. Bruder Stapleton, MD, and Maneesh Batra, MD, MPH
The University of Washington Pediatric Residency Program Experience in Global Health and Community Health and Advocacy embodies essential principles of successful short-term rotations from academic medical centers to resource-limited countries.