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.
New brain imaging suggests that asking patients to put themselves in their surrogates’ shoes when thinking about advance directives might lead to directives that better line up with what surrogates think they should decide.
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.
Taking care of patients whose cultures, belief systems, and family hierarchy structures differ from those on which many U.S. laws and regulations involves strategies—particularly regarding end-of-life care and surrogate decision making.
Taking care of patients whose cultures, belief systems, and family hierarchy structures differ from those on which many U.S. laws and regulations involves strategies—particularly regarding end-of-life care and surrogate decision making.
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.