When Needs Collide: The Role of Surrogate Preferences in Medical Decision-Making for Incapacitated Adults
Thursday, October 12, 2023
4:00 PM – 5:15 PM ET
Location: Iron (Fourth Floor)
If a patient loses decisional capacity, their surrogate decision-makers are expected to make decisions that best protect the patient’s autonomy and wellbeing. However, there is evidence that, rather than using strict substituted judgment, surrogates often project their own values and incorporate their own interests when making decisions for patients. Many capacitated patients wish to incorporate the needs and preferences of loved ones into their medical decisions as an expression of relational autonomy, acknowledging that relationships with and responsibilities to others shape self-directed choices. But does relational autonomy have a role to play for incapacitated patients? Should we accommodate the needs of surrogate decision-makers if patients are unable to negotiate perceived discrepancies between their own preferences and those of their loved ones, and to what degree? This talk will summarize data exploring patient and physician perspectives on the ethics of accommodating the needs of surrogate decision-makers of incapacitated adults. The session will then discuss the current model by which surrogate decision-makers are expected to make decisions, the ways in which they stray from those expectations, and how accommodating the needs of surrogate decision-makers could impact patients, clinicians, and the healthcare system. Finally, this talk will conclude by theorizing about how to strike a practical and ethical balance when there is a perceived conflict between the needs and wishes of a patient and those of their surrogate decision-maker.