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.
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.
Quality improvement initiatives in clinical medicine are part research and part patient care and pose challenges to traditional forms of ethical oversight.
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.