Proxy Consent by a Physician When a Patientís Capacity Is Equivocal: Respecting a Patientís Autonomy by Overriding the Patientís Ostensible Treatment Preferences

Abraham Graber, Carolyn April, and Michael D. April, The Journal of Clinical Ethics 29, no. 4 (Winter 2018): 266-75.

            Respect for patientsí autonomy has taken a central place in the practice of medicine. Received wisdom holds that respect for autonomy allows overriding a patientís treatment preferences only if the patient has been found to lack capacity. This understanding of respect for autonomy requires a dichotomous approach to assessing capacity, whereby a patient must be found either to have full capacity to make some particular treatment decision or must be found to lack capacity to make that decision. However, clinical reality is more complicated, and, in borderline cases, different physicians may arrive at disparate judgments of capacity. In such cases, when capacity-determination protocols fail to achieve consensus, physicians would benefit from guidance regarding the clinical decision-making process necessary to elucidate the most ethically sound course of action. This article considers one such case and argues that, in a limited number of cases, respect for autonomy may require overriding a patientís stated treatment preference when a capacity determination is equivocal, even though the patient has not clearly demonstrated a lack of capacity.


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