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.
Nancy Berlinger, PhD and Annalise Berlinger, BSN, RN
Physicians’ reliance on “culture” to explain patients’ noncompliance may serve as code for their discomfort with difference, uncertainty, and distress.
AMA J Ethics. 2017;19(6):608-616. doi:
10.1001/journalofethics.2017.19.6.msoc1-1706.
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.
Immigrant patients are often bewildered when they need to seek health care in the U.S., and that care usually comes from physicians who are unsympathetic to their plight.