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1 July 2008 | Volume 149 Issue 1 | Pages 48-53
The care of adult patients without decision-making abilities is a routine part of medical practice. Decisions for these patients are typically made by surrogates according to a process governed by a hierarchy of 3 distinct decision-making standards: patients' known wishes, substituted judgments, and best interests. Although this framework offers some guidance, it does not readily incorporate many important considerations of patients and families and does not account for the ways in which many patients and surrogates prefer to make decisions. In this article, the authors review the research on surrogate decision making, compare it with normative standards, and offer ways in which the 2 can be reconciled for the patient's benefit.
Author and Article Information
From School of Medicine, State University of New York at Stony Brook, Stony Brook, New York; Washington Hospital Center, Washington, DC; and the Office of the Attorney General of Maryland, Baltimore, Maryland.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Jeffrey T. Berger, MD, 222 Station Plaza North, Suite 518, Mineola, NY 11501; e-mail, jberger{at}winthrop.org.
Current Author Addresses: Dr. Berger: 222 Station Plaza North, Suite 518, Mineola, NY 11501.
Dr. DeRenzo: 4 Grovepoint Court, Rockville, MD 20854.
Mr. Schwartz: 12203 Linden Linthicum Lane, Clarksville, MD 21029. PERSPECTIVE
Surrogate Decision Making: Reconciling Ethical Theory and Clinical Practice
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