Making Medical Decisions for Incapacitated Patients Without Proxies: Part II
Tóm tắt
In the United States, there is no consensus about who should make decisions in acute but non-emergent situations for incapacitated patients who lack surrogates. For more than a decade, our academic medical center has utilized community volunteers from the hospital ethics committee to engage in shared decision-making with the medical providers for these patients. In order to add a different point of view and minimize conflict of interest, the volunteers are non-clinicians who are not employed by the hospital. Using case examples and interviews with the community members, this paper describes how the protocol has translated into practice over the years since its inception. Members reported comfort with the role as well as satisfaction with the thoroughness of their discussions with the medical team. They acknowledged feelings of moral uncertainty, but expressed confidence in the process. Questions raised by the experience are discussed. Overall, the protocol has provided oversight, transparency, and protection from conflict of interest to the decision-making process for this vulnerable patient population.
Tài liệu tham khảo
Courtwright, A. M., Abrams, J., & Robinson, E. M. (2017). The role of a hospital ethics consultation service in decision-making for unrepresented patients. Journal of Bioethical Inquiry,14(2), 241–250.
Courtwright, A., & Rubin, E. (2015). Who should decide for the unrepresented? Bioethics,30(3), 173–180.
Ditto, P. H., Danks, J. H., Smucker, W. D., Bookwala, J., Coppola, K. M., Dresser, R., et al. (2001). Advance directives as acts of communication: A randomized controlled trial. Archives of Internal Medicine,161(3), 421–430.
Elwyn, G., Frosch, D., Thomson, R., Joseph-Williams, N., Lloyd, A., Kinnersley, P., et al. (2012). Shared decision making: A model for clinical practice. Journal of General Internal Medicine,27(10), 1361–1367.
Fagerlin, A., Ditto, P. H., Danks, J. H., Houts, R. M., & Smucker, W. D. (2001). Projection in surrogate decisions about life-sustaining medical treatments. Health Psychology,20(3), 166–175.
Griggins, C., Blackstone, E., McAliley, L. et al. (2019). Making medical decisions for incapacitated patients without proxies: Part I. HEC Forum. https://doi.org/10.1007/s10730-019-09387-3.
Hyun, I., Griggins, C., Weiss, M., Robbins, D., Robichaud, A., & Daly, B. (2006). When patients do not have a proxy: A procedure for medical decision making when there is no one to speak for the patient. Journal of Clinical Ethics,17(4), 323–330.
Janis, I. L. (1972). Victims of groupthink. Boston: Houghton Mifflin.
Kim, H., & Song, M. (2018). Medical decision-making for adults who lack decision-making capacity and a surrogate: State of the science. American Journal of Hospice and Palliative Medicine,35(9), 1227–1234.
Pope, T. M. (2017). Unbefriended and unrepresented: Better medical decision making for incapacitated patients without healthcare surrogates. Georgia State University Law Review,33(4), 923–1019.
Prang, K. H., Berecki-Gisolf, J., & Newnam, S. (2015). Recovery from musculoskeletal injury: The role of social support following a transport accident. Health and Quality of Life Outcomes,13, 97.
Robichaud, A. L. (2015). Medical decision making for patients without proxies: The effect of personal experience in the deliberative process. Journal of Clinical Ethics,26(4), 355–360.
Sequeira, A., & Lewis, A. (2017). Ethical and legal considerations in the management of an unbefriended patient in a vegetative state. Neurocritical Care,27(2), 173–179.
Treen, E., Atanasova, C., Pitt, L., & Johnson, M. (2016). Evidence from a large sample on the effects of group size and decision-making time on performance in a marketing simulation game. Journal of Marketing Education,38(2), 130–137.
White, D. B., Curtis, J. R., Lo, B., & Luce, J. M. (2006). Decisions to limit life-sustaining treatment for critically ill patients who lack both decision-making capacity and surrogate decision-makers. Critical Care Medicine,34(8), 2053–2059.
White, D. B., Curtis, J. R., Wolf, L. E., Prendergast, T. J., Taichman, D. B., Kuniyoshi, G., et al. (2007). Life support for patients without a surrogate decision maker: Who decides? Annals of Internal Medicine,147(1), 34–40.
White, D. B., Johnsen, A., & Lo, B. (2012). Ethical challenge: When clinicians act as surrogates for unrepresented patients. American Journal of Critical Care,21(3), 202–207.