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.
“Difficult” patient encounters can be exacerbated by procedural and technological infrastructure that increases access to electronic health records (EHRs).
AMA J Ethics. 2017;19(4):374-380. doi:
10.1001/journalofethics.2017.19.4.stas1-1704.
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.
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.
The future success of the Affordable Care Act depends on doctors' willingness to take the lead in identifying reforms that will lead to high-quality, cost-effective health care.