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Wednesday, September 9, 2015

American College of Physicians Ethics Manual: Sixth EditionACP Ethics Manual | Annals of...

So you are a surrogate decision-maker for your loved one. What does that mean? Well, if the patient still has decisional capacity, being a surrogate does not mean much. In general, the patient will continue to make decisions for him or herself. As a designated surrogate, consider yourself to be inactive, on the bench, in a holding pattern, on pause, an understudy, what have you...your voice does not replace or supersede the patient's. You may be in this "holding pattern" for weeks, months or years. When a patient is unable to make his or her own decisions, the ethical principle of substituted judgment obliges surrogate decision makers to make decisions that are consistent with the patient's previously expressed wishes and values. This principle, called “substituted judgment,” essentially asks, “What would the patient want if he or she could decide?” Sometimes that decision may be conflict with your own personal views or how you may personally chose. However, as a surrogate decision-maker the obligation is to make the decision as that person would have and not as you yourself desire. The obligation is to continue to make decisions that are consistent with the patient's previously expressed wishes and values. Wishes and values may be explicit (stated or written down) or implicit (inferred from how that person lived their life and choices made). If you have a religious or moral position that differs from the patient's wishes and values, the obligation still stands. If you are unable to fulfill this obligation, it may be advisable to not accept the role as a surrogate decision-maker. As one of our local chaplains put it, "Just because the patient no longer has a voice does not give us permission to wail upon him as if his wishes were unknown." Source:
from Rajesh Harrykissoon, MD * Members of the Ethics, Professionalism, and Human Rights Committee, 2009–2012, who developed and approved this sixth edition of the Manual: Virginia L. Hood, MBBS, MPH (Chair, 2009–2010); Kesavan Kutty, MD (Chair, 2010–2012); Joseph J. Fins, MD (Vice Chair, 2009–2011); Ana María López, MD, MPH (Vi…

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