Skip to main content
SpringerLink
Log in

Ethical Conflicts in Surrogate Decision Making

  • Chapter
  • First Online:
Difficult Decisions in Surgical Ethics

Part of the book series: Difficult Decisions in Surgery: An Evidence-Based Approach ((DDSURGERY))

Abstract

Once patients are too sick to make healthcare decisions for themselves, this task is relegated to their surrogate decision makers. Because of the complexity and ever-changing nature of these decisions, it is not surprising that conflicts arise between various stakeholders in this process. Furthermore, the variability of state law on surrogate decision making may further cloud decision-making, ultimately delaying, and sometimes undermining, patient care. This chapter examines the nature and causes of conflicts in surrogate decision making, outlines the ethical dilemmas embedded therein, and offers an overview of practically useful approaches to the resolution of ethically challenging surrogate decision making.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Bernat JL. Ethical issues in neurology. 2nd ed. Butterworth-Heinemann; 2002. p. 87–91.

    Google Scholar 

  2. World Health Organization. PAHO. Covid-19 has infected some 570,000 health workers and killed 2500 in the Americas, PAHO Director says. September 2, 2020. Accessed January 11, 2021. https://www.paho.org/en/news/2-9-2020-covid-19-has-infected-some-570000-health-workers-and-killed-2500-americas-paho.

  3. Shalowitz DI, Garrett-Mayer E, Wendler D. The accuracy of surrogate decision makers: a systematic review. Arch Intern Med. 2006;166(5):493–7. https://doi.org/10.1001/archinte.166.5.493.

    Article  PubMed  Google Scholar 

  4. Hinkle LJ, Bosslet GT, Torke AM. Factors associated with family satisfaction with end-of-life care in the ICU: a systematic review. Chest. 2015;147(1):82–93. https://doi.org/10.1378/chest.14-1098.

    Article  PubMed  Google Scholar 

  5. Kopar PK, Brown DE, Turnbull IR. Ethics of codes and codes of ethics: when is it ethical to provide cardiopulmonary resuscitation during the COVID-19 pandemic? Ann Surg. 2020;272(6):930–4. https://doi.org/10.1097/sla.0000000000004318.

    Article  PubMed  Google Scholar 

  6. Moore RF. A guide to the assessment and Care of the Patient Whose Medical Decision-Making Capacity is in question. Med Gen Med 1999:E7. PMID: 11104409.

    Google Scholar 

  7. Venkat A, Becker J. The effect of statutory limitations on the authority of substitute decision makers on the care of patients in the intensive care unit: case examples and review of state laws affecting withdrawing or withholding life-sustaining treatment. J Intensive Care Med. 2014;29(2):71–80. https://doi.org/10.1177/0885066611433551.

    Article  PubMed  Google Scholar 

  8. Mehter HM, McCannon JB, Clark JA, Wiener RS. Physician approaches to conflict with families surrounding end-of-life decision-making in the intensive care unit. A qualitative study. Ann Am Thorac Soc. 2018;15(2):241–9. https://doi.org/10.1513/annalsats.201702-105OC.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Lee MA, Smith DM, Fenn DS, Ganzini L. Do patients’ treatment decisions match advance statements of their preferences? J Clin Ethics 1998;9(3):258–262. PMID: 10029826.

    Google Scholar 

  10. Kramer BJ, Boelk AZ. Correlates and predictors of conflict at the end of life among families enrolled in hospice. J Pain Symptom Manag. 2015;50(2):155–62. https://doi.org/10.1016/j.jpainsymman.2015.02.026.

    Article  Google Scholar 

  11. Schuster RA, Hong SY, Arnold RM, White DB. Investigating conflict in ICUs-is the clinicians’ perspective enough? Crit Care Med. 2014;42(2):328–35. https://doi.org/10.1097/ccm.0b013e3182a27598.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Steinhauser AE, Christakis NA, Clipp EC, McNeilly M, McIntyre L, Tulsky JA. Factors considered important at the end of life by patients, family, physicians, and other care providers. JAMA. 2000;284(19):2476–82. https://doi.org/10.1001/jama.284.19.2476.

    Article  CAS  PubMed  Google Scholar 

  13. Parks SM, Winter L, Santana AJ, et al. Family factors in end-of-life decision-making: family conflict and proxy relationship. J Palliat Med. 2011;14(2):179–84. https://doi.org/10.1089/jpm.2010.0353.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Kant: Groundwork of the Metaphysics of Morals: Edition 2 (revised). In: Gregor M, Timmermann J, Korsgaard CM, editors. Cambridge University Press; 2012; p. 37–108.

    Google Scholar 

  15. Beauchamp TL, Childress JF. Principles of biomedical ethics. 8th ed. Oxford University Press; 2019. Chapter 4

    Google Scholar 

  16. Nedelsky J. Law’s relations: a relational theory of self, autonomy, and law. Oxford University Press; 2011.

    Google Scholar 

  17. Ho A. Relational autonomy or undue pressure? Family’s role in medical decision-making. Scand J Caring Sci. 2008;22(1):128–35. https://doi.org/10.1111/j.1471-6712.2007.00561.x.

    Article  PubMed  Google Scholar 

  18. Gilbar R. Family involvement, independence, and patient autonomy in practice. Med Law Rev. 2011;19(2):192–234. https://doi.org/10.1093/medlaw/fwr008.

    Article  PubMed  Google Scholar 

  19. Hardwig J. Is there a duty to die? Hast Cent Rep. 1997;27(2):34–42. https://doi.org/10.2307/3527626.

    Article  CAS  Google Scholar 

  20. Nelson JL. Taking families seriously. Hast Cent Rep. 1992;22(4):6–12. https://doi.org/10.2307/3563016.

    Article  Google Scholar 

  21. Schram AW, Hougham GW, Meltzer DO, Ruhnke GW. Palliative Care in Critical Care Settings: a systematic review of communication-based competencies essential for patient and family satisfaction. Am J Hosp Palliat Med. 2017;34(9):887–95. https://doi.org/10.1177/1049909116667071.

    Article  Google Scholar 

  22. Baker FX, Gallagher CM. Identifying and managing undue influence from family members in end-of-life decisions for patients with advanced Cancer. J Oncol Pract. 2017;13(10):702, e857–e862. https://doi.org/10.1200/jop.2017.020792.

  23. Seaman JB, Arnold RM, Scheunemann LP, White DB. An integrated framework for effective and efficient communication with families in the adult intensive care unit. Ann Am Thorac Soc. 2017;14(6):1015–0. https://doi.org/10.1513/annalsats.201612-9655OI.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Lilly CM, De Meo DL, Sonna LA, et al. An intensive communication intervention for the critically ill. Am J Med. 2000;109(6):469–75. https://doi.org/10.1016/s0002-9343(00)00524-6.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Washington University in Saint Louis School of Medicine, Saint Louis, MO, USA

    Leah Conant

  2. Department of Surgery, Center for Humanism and Ethics in Surgical Specialties, Washington University in St. Louis School of Medicine, St. Louis, MO, USA

    Piroska Kopar

Authors
  1. Leah Conant
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Piroska Kopar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Piroska Kopar .

Editor information

Editors and Affiliations

  1. The University of Chicago Medicine, University of Chicago, Chicago, IL, USA

    Vassyl A. Lonchyna

  2. Providence Children’s Surgical Services St. Vincent Hospital, Portland, OR, USA

    Peggy Kelley

  3. Department of Surgery MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, IL, USA

    Peter Angelos

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Conant, L., Kopar, P. (2022). Ethical Conflicts in Surrogate Decision Making. In: Lonchyna, V.A., Kelley, P., Angelos, P. (eds) Difficult Decisions in Surgical Ethics. Difficult Decisions in Surgery: An Evidence-Based Approach. Springer, Cham. https://doi.org/10.1007/978-3-030-84625-1_39

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-84625-1_39

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-84624-4

  • Online ISBN: 978-3-030-84625-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation