Classifying the Contradiction: A Practical Approach When Surrogates Appear to Contradict a Patient’s Wishes

Abstract

Cases in which a surrogate’s decision appears to contradict a patient’s wishes can be challenging to navigate. Both surrogates and healthcare professionals have an ethical obligation to honor the patient’s authentic wishes. When that preference is unclear, or seemingly clear but a surrogate insists otherwise, healthcare professionals may struggle with how best to fulfill their responsibility. This chapter offers a method for classifying cases of apparent contradiction into one of three categories: (1) True Contradiction; (2) Partial Picture Bias; or (3) Internal Contradiction. Using a framework called The Five Cs, the chapter explains how to clarify the patient’s authentic preferences and pinpoint the relevant category of contradiction. Finally, for each category, the chapter outlines a healthcare team’s obligations and identifies ways that clinical ethics consultants can support stakeholders to honor a patient’s authentic wishes.