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HEC Forum

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Making Medical Decisions for Incapacitated Patients Without Proxies: Part II

  • Eric BlackstoneEmail author
  • Barbara J. Daly
  • Cynthia Griggins
Article
  • 21 Downloads

Abstract

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.

Keywords

Unbefriended Unrepresented Surrogate decision-making Substituted judgment Ethics committees 

Notes

Acknowledgements

Olubukunola Dwyer and Lauren McAliley for assisting with the interviews, and the PWP committee volunteers.

Compliance with Ethical Standards

Conflict of interest

The authors have no conflict of interest to disclose.

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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Frances Payne Bolton School of NursingCase Western Reserve UniversityClevelandUSA
  2. 2.Case Western Reserve UniversityClevelandUSA
  3. 3.Department of Neurology, Neurological Institute, University Hospitals Cleveland Medical CenterCase Western Reserve University School of MedicineClevelandUSA

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