Physicians, committees, and guardians all make decisions for unrepresented patients in the US. This article considers a “tiered” approach as an alternative.
When patients are unable to express their wishes and do not have surrogates or advance directives, which and whose values should inform decision making for them? We discuss ethical complexities of caring for unrepresented patients.
Dichotomies, such as reconstructive vs aesthetic surgery and medical vs cosmetic dermatology, can distort meanings of surgical procedures. This can compromise the value of procedures themselves and practices for their reimbursement.
A guardian’s request to sterilize a woman with intellectual disabilities is not ethically justifiable unless the woman assents and it is to her benefit.
Women who are pregnant might not treat their mental illnesses because they overestimate risks of medication and underestimate risks of leaving their illness untreated.
Shared decision making honors patient autonomy, particularly for preference-sensitive care decisions and even when patients have impaired decision-making capacity.
Patrick S. Phelan, Mary C. Politi, PhD, and Christopher J. Dy, MD, MPH
During immediate and long-term recovery periods, decisions must account for patients’ personal goals and possible clinical outcomes and should clarify what recovery means.
Shared decision making is practically difficult to implement in mental health practice but remains an ethical ideal for motivating therapeutic capacity.