Incapacitated Surrogates: A New and Increasing Dilemma in Hospital Care


Karen L. Smith, Patrice Fedel, and Jay Heitman, The Journal of Clinical Ethics 28, no. 4 (Winter 2017): 279-84.


A power of attorney for healthcare (POAHC) form gives designated individuals legal status to make healthcare decisions when patients are unable to convey their decisions to medical staff. Completion of a POAHC form is crucial in the provision of comprehensive healthcare, since it helps to ensure that patientsí interests, values, and preferences are represented in decisions about their medical treatment. Because increasing numbers of people suffer from debilitating illness and cognitive deficits, healthcare systems may be called upon to navigate the complexities of patientsí care without clear directives from the patients themselves. Hence, the healthcare industry encourages all individuals to complete a POAHC form to ensure that persons who have the patientsí trust are able to act as their surrogate decision makers. However, sometimes POAHC agents, even when they are patientsí trusted agents, lack the capacity to make fully informed decisions that are in the patientsí best interests. We describe designated surrogate decision makers who have impaired or diminished judgment capacity as incapacitated surrogates. Decision making that is obviously flawed or questionable is a significant impediment to providing timely and appropriate care to patients. Moreover, failure to redress these issues in a timely and efficient manner can result in significant costs to an institution and a diminished quality of patient care. The authors offer a legal, ethical, and interdisciplinary framework to help navigate cases of incapacitated surrogates.




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