scholarly journals Substituted decision making and the dispositional choice account

2018 ◽  
Vol 44 (10) ◽  
pp. 703.1-709 ◽  
Author(s):  
Anna-Karin Margareta Andersson ◽  
Kjell Arne Johansson
Keyword(s):  
Decision Making ◽  
Best Interests ◽  
Surrogate Decision Making ◽  
Substituted Judgment ◽  
Legal Context ◽  
Surrogate Decision ◽  
Best Interests Standard ◽  
Unconscious Patients ◽  
Substituted Judgment Standard

There are two main ways of understanding the function of surrogate decision making in a legal context: the Best Interests Standard and the Substituted Judgment Standard. First, we will argue that the Best Interests Standard is difficult to apply to unconscious patients. Application is difficult regardless of whether they have ever been conscious. Second, we will argue that if we accept the least problematic explanation of how unconscious patients can have interests, we are also obliged to accept that the Substituted Judgment Standard can be coherently applied to patients who have never been conscious at the same extent as the Best Interests Standard. We then argue that acknowledging this result is important in order to show patients respect.

scholarly journals The judgment grounds in surrogate decision-making in Japanese clinical practice: A qualitative survey

2020 ◽  
Author(s):  
Masashi Tanaka ◽  
Kayoko Ohnishi ◽  
Aya Enzo ◽  
Taketoshi Okita ◽  
Atsushi Asai
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Best Interests ◽  
Current Status ◽  
Surrogate Decision Making ◽  
Inclusion Criteria ◽  
Surrogate Decision ◽  
Factor Type ◽  
Family Preference ◽  
Made In

Abstract Background Surrogate decision-making is expected to become more prevalent in Japanese clinical practice. In recent years, activities to promote advanced care planning (ACP) have gathered momentum, which may potentially affect the ways in which judgments are made in surrogate decision-making. The purpose of this study is to clarify the current judgment grounds on which surrogate decisions are made in Japan. Methods We adopted a qualitative research method that was based on semi-structured interviews to reveal the judgment grounds in surrogate decision-making involving critical, life-sustaining treatment choices in acute hospitals.  Results We received a list of 228 participants who met the inclusion criteria. Of these, we interviewed 15 participants. We analyzed the content of the 14 transcribed texts, eliminating one text that did not meet the inclusion criteria. We extracted a total of four core categories, 17 categories, 35 subcategories, and 55 codes for qualitative analysis of interviews regarding the judgement grounds in surrogate decision-making. The four core categories are as follows: Type 1 "Patient preference-oriented factor," Type 2 "Patient interest-oriented factor," Type 3 "Family preference-oriented factor," and Type 4 "Balanced patient/family preference-oriented factor." Type 4 was the reasoning related to an attempt to balance preferences of the patient and those of the surrogate decision-maker.  Conclusions This study revealed the current status of surrogate decision-making about important matters related to a patient’s life in Japan. Surrogate decision-makers base their decisions not only on the preferences and best interests of the patient, but on their own preferences as well. In the future, we believe that surrogate decisions-makers will be required to consider the judgment grounds from a more diverse perspective and that such attitudes should be ethically accepted. 

Surrogate Decision-making for Incompetent Elderly Patients: The Role of Informal Representatives

2012 ◽  
Vol 19 (1) ◽  
pp. 61-68 ◽  
Author(s):  
Sjef Gevers ◽  
Joseph Dute ◽  
Herman Nys
Keyword(s):  
Decision Making ◽  
Best Interests ◽  
Surrogate Decision Making ◽  
Next Of Kin ◽  
Incompetent Patient ◽  
The Law ◽  
European Standards ◽  
Surrogate Decision ◽  
Informal Approach

Abstract Informal or unofficial representation refers to the practice (more common in some European jurisdictions than in others), that persons not designed by a court or by the patient himself, make medical decisions on the patient’s behalf in case of their incompetence. If the law provides for this, it is usually next of kin (spouse, children, brothers and sisters, etc.) who are allowed to act in such a capacity. Informal representation raises several questions. Are family members always familiar with what their relative would have wished, ready to take responsibility, and not too much reigned by their emotions? The basic legal concern is whether there are sufficient procedural and other safeguards to protect the incompetent patient from representatives who do not serve their best interests. In addressing these issues, after a brief survey of the law in the Netherlands as compared with that in Belgium, Germany and England/Wales, we will argue that informal representation as such is not at variance with international and European standards. However, an ‘informal’ approach to surrogate decision-making should always go together with sufficient protection of the incompetent patient, including procedural safeguards with regard to the decision that the patient is incompetent, limits to the decision-making power of informal representatives and effective forms of conflict resolution.

scholarly journals The judgment grounds in surrogate decision-making in Japanese clinical practice: A qualitative survey

2020 ◽  
Author(s):  
Masashi Tanaka ◽  
Kayoko Ohnishi ◽  
Aya Enzo ◽  
Taketoshi Okita ◽  
Atsushi Asai
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Decision Makers ◽  
Best Interests ◽  
Current Status ◽  
Surrogate Decision Making ◽  
Surrogate Decision Makers ◽  
Surrogate Decision ◽  
Family Preference ◽  
Made In

Abstract Background Surrogate decision-making is expected to become more prevalent in Japanese clinical practice. In recent years, activities to promote advanced care planning (ACP) have gathered momentum ,which may potentially affect the ways in which judgments are made in surrogate decision-making. The purpose of this study is to clarify the current judgment grounds on which surrogate decisions are made in Japan. Methods We adopted a qualitative research method that was based on semi-structured interviews to reveal the judgement grounds in surrogate decision-making involving critical, life-related choices in acute hospitals. Results We interviewed 15 participants. We analyzed the content of the 14 transcribed texts, eliminating one text that does not meet the inclusion criteria. We extracted a total of 4 core categories, 17 categories, 35 subcategories, and 55 codes as an analysis results of interviews regarding the judgment grounds in surrogate decision-making. The four categories are as follows: type 1“Patient preference-oriented factor”, type2“Patient interest-oriented factor”, type3“Family preference-oriented factor”,and type4 “Balanced patient/family preference-oriented factor”. Conclusions This study revealed the current status of surrogate decision-making in Japan: when making decisions about important matters related to a patient’s life, surrogate decision-makers base their decisions not only on the preferences and best interests of the patient, but on their own preferences as well. Included in the preferences of surrogate decision-makers were their own views of life and death, their values, and care burden. Given the cultural and social backgrounds in Japan, it remains unclear whether ACP can be properly reflected in judgment grounds in surrogate decision-making. It would be undesirable to base judgments solely on the principle of respect for autonomy or the principles of surrogate decision-making. In the future, we believe that surrogate decisions-makers will be required to consider the judgment grounds from a more diverse perspective and that such attitudes should be ethically accepted.

Advance Care Planning and Surrogate Decision-Making (DRAFT)

2018 ◽  
Author(s):  
Robert C. Macauley
Keyword(s):  
Decision Making ◽  
Decision Maker ◽  
Patient Autonomy ◽  
Best Interests ◽  
Evidence Based ◽  
Surrogate Decision Maker ◽  
Substituted Judgment ◽  
Decision Making Capacity ◽  
Advance Care ◽  
Surrogate Decision

Adult patients are presumed to possess decision-making capacity, but when they are unable to make their own decisions—which is especially frequent in the context of serious illness—ideally a surrogate decision-maker will be able to determine what the patient would have wanted (i.e., substituted judgment). Only when this is not possible is it necessary to fall back on what seems to be in the patient’s best interests. To foster patient autonomy, goals and values should be identified and documented in advance, such as in an advance directive, as well as a surrogate decision-maker named. This helps guide the medical team in critical and often uncertain times, given the challenges in accurate prognostication (which are lessening with the advent of evidence-based tools).

Substituted Judgment in Medical Practice: Evidentiary Standards on a Sliding Scale

1997 ◽  
Vol 25 (1) ◽  
pp. 22-29 ◽  
Author(s):  
Mark R. Tonelli
Keyword(s):  
Decision Making ◽  
Daily Practice ◽  
Medical Decision ◽  
Sufficient Evidence ◽  
State Court ◽  
Substituted Judgment ◽  
Sliding Scale ◽  
Surrogate Decision ◽  
Evidentiary Standards ◽  
Substituted Judgment Standard

Consensus is growing among ethicists and lawyers that medical decision making for incompetent patients who were previously competent should be made in accordance with that person's prior wishes and desires. Moreover, this legal and ethical preference for the substituted judgment standard has found its way into the daily practice of medicine. However, what appears on the surface to be an agreement between jurists, bioethicists, and clinicians obscures the very real differences between disciplines regarding the actual implementation of the sub stituted judgment standard. Ethicists and judges have carefully outlined how substituted judgments ought to be made and evaluated. Although differences arise, especially at the state court level, regarding the scope of the substituted judgment standard and its relation to other standards of surrogate decision making, agreement is fairly widespread on the priority of substituted judgment and on the necessity of sufficient evidence being available in order to support a particular substituted judgment.

scholarly journals Grounds for surrogate decision-making in Japanese clinical practice: a qualitative survey

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Masashi Tanaka ◽  
Kayoko Ohnishi ◽  
Aya Enzo ◽  
Taketoshi Okita ◽  
Atsushi Asai
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Decision Makers ◽  
Best Interests ◽  
Surrogate Decision Making ◽  
Inclusion Criteria ◽  
Surrogate Decision Makers ◽  
Surrogate Decision ◽  
Factor Type ◽  
Family Preference

Abstract Background In the coming years, surrogate decision-making is expected to become highly prevalent in Japanese clinical practice. Further, there has been a recent increase in activities promoting advance care planning, which potentially affects the manner in which judgements are made by surrogate decision-makers. This study aims to clarify the grounds on which surrogate decision-makers in Japan base their judgements. Methods In this qualitative study, semi-structured interviews were conducted to examine the judgement grounds in surrogate decision-making for critical life-sustaining treatment choices in acute care hospitals. Results A total of 228 participants satisfied the inclusion criteria, and 15 were selected for interviews. We qualitatively analysed the content of 14 interview transcripts, excluding one that did not meet the inclusion criteria. Based on this analysis, we extracted 4 core categories, 17 categories, 35 subcategories, and 55 codes regarding judgement grounds in surrogate decision-making. The four core categories were as follows: patient preference-oriented factor (Type 1), patient interest-oriented factor (Type 2), family preference-oriented factor (Type 3), and balanced patient/family preference-oriented factor (Type 4). The Type 4 core category represented attempts to balance the preferences of the patient with those of the surrogate decision-maker. Conclusions Surrogate decision-makers based their decisions on important aspects related to a patient’s life, and they considered not only the patient’s preferences and best interests but also their own preferences. As the need for surrogate decisions will increase in the future, decision-makers will need to consider judgement grounds from a more diverse perspective.

A new kind of paternalism in surrogate decision-making? The case of Barnsley Hospitals NHS Foundation Trust v MSP

2020 ◽  
pp. medethics-2020-106797
Author(s):  
Scott Y H Kim ◽  
Alexander Ruck Keene
Keyword(s):  
Decision Making ◽  
Best Interests ◽  
Medical Decision ◽  
Negative Consequences ◽  
Substituted Judgment ◽  
Mental Capacity Act 2005 ◽  
Values And Beliefs ◽  
Life Sustaining Treatment ◽  
Surrogate Decision ◽  
Mental Capacity Act

The modern legal and ethical movement against traditional welfare paternalism in medical decision-making extends to how decisions are made for patients lacking decisional capacity, prioritising surrogates’ judgment about what patients would have decided over even their best interests. In England and Wales, the Mental Capacity Act 2005 follows this trend of prioritising the patient’s prior wishes, values and beliefs but the dominant interpretation in life-sustaining treatment cases does so by in effect calling those values the ‘best interests’ of the patient and focusing nearly exclusively on the ‘subjective’ viewpoint of the patient. In this article, we examine the recent Court of Protection judgment in Barnsley Hospitals NHS Foundation Trust v MSP [2020] EWCOP 26, which adhered closely to this approach, to suggest that it could have unexpected negative consequences. These include insufficient information gathering about and attention to patients’ objective medical interests, inadequacy of the evidentiary standard used for the substituted decision-making and, in some cases, even prioritising a surrogate’s current substituted judgment over the potential for an actual judgment by the patient.

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