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.
Anne-Marie Laberge, MD, PhD and Wylie Burke, MD, PhD
Physicians and counselors must address the importance of communicating genetic test results to family members in the pre-test counseling and informed-consent processes prior to testing.
Asymmetry in knowledge and power between (1) physicians and patients and (2) physician educators and their students creates a climate for possible abuse in both sets of relationships.
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.