HEC Forum

, Volume 29, Issue 2, pp 145–169 | Cite as

Licensing Surrogate Decision-Makers

  • Philip M. RosoffEmail author


As medical technology continues to improve, more people will live longer lives with multiple chronic illnesses with increasing cumulative debilitation, including cognitive dysfunction. Combined with the aging of society in most developed countries, an ever-growing number of patients will require surrogate decision-makers. While advance care planning by patients still capable of expressing their preferences about medical interventions and end-of-life care can improve the quality and accuracy of surrogate decisions, this is often not the case, not infrequently leading to demands for ineffective, inappropriate and prolonged interventions. In 1980 LaFollette called for the licensing of prospective parents, basing his argument on the harm they can do to vulnerable people (children). In this paper, I apply his arguments to surrogate decision-makers for cognitively incapacitated patients, rhetorically suggesting that we require potential surrogates to qualify for this position by demonstrating their ability to make reasonable and rational decisions for others. I employ this theoretical approach to argue that the loose criteria by which we authorize surrogates’ generally unchallenged power should be reconsidered.


Surrogate decision-making Licensing Harm 


Compliance with Ethical standards

Conflict of interest

The author has none to declare.


  1. Alpers, A., & Lo, B. (1999). Avoiding family feuds: Responding to surrogate demands for life-sustaining interventions. The Journal of Law Medicine & Ethics, 27(1), 74–80.CrossRefGoogle Scholar
  2. Angus, D. C., Barnato, A. E., Linde-Zwirble, W. T., Weissfeld, L. A., Watson, R. S., Rickert, T., et al. (2004). Use of intensive care at the end of life in the United States: An epidemiologic study. Critical Care Medicine, 32(3), 638–643.CrossRefGoogle Scholar
  3. Azoulay, E., Chevret, S., Leleu, G., Pochard, F., Barboteu, M., Adrie, C., et al. (2000). Half the families of intensive care unit patients experience inadequate communication with physicians. Critical Care Medicine, 28(8), 3044–3049.CrossRefGoogle Scholar
  4. Barrio-Cantalejo, I. M., Molina-Ruiz, A., Simon-Lorda, P., Camara-Medina, C., Toral Lopez, I., del Mar Rodriguez del Aguila, M., et al. (2009). Advance directives and proxies’ predictions about patients’ treatment preferences. Nursing Ethics, 16(1), 93–109. doi: 10.1177/0969733008097995.CrossRefGoogle Scholar
  5. Berger, J. T., DeRenzo, E. G., & Schwartz, J. (2008). Surrogate decision making: Reconciling ethical theory and clinical practice. Annals of Internal Medicine, 149(1), 48–53.CrossRefGoogle Scholar
  6. Bopp, J., & Coleson, R. E. (1994). Child abuse by whom?—parental rights and judicial competency dterminations: The Baby K and Baby Terry cases. Ohio Northern University Law Review, 20, 821–845.Google Scholar
  7. Bramstedt, K. A. (2003). Questioning the decision-making capacity of surrogates. Internal Medicine Journal, 33(5–6), 257–259. doi: 10.1046/j.1445-5994.2003.00386.x.CrossRefGoogle Scholar
  8. Buchanan, A. E., & Brock, D. W. (1989). Deciding for others: The ethics of surrogate decision making. Cambridge: Cambridge University Press.Google Scholar
  9. Cassell, E. J. (1991). Recognizing Suffering. Hastings Center Report, 21(3), 24–31.CrossRefGoogle Scholar
  10. Cassell, E. J. (1999). Diagnosing Suffering: A Perspective. Annals of Internal Medicine, 131(7), 531–534.CrossRefGoogle Scholar
  11. Castillo, L. S., Williams, B. A., Hooper, S. M., Sabatino, C. P., Weithorn, L. A., & Sudore, R. L. (2011). Lost in translation: The unintended consequences of advance directive law on clinical care. Annals of Internal Medicine, 154(2), 121–128. doi: 10.1059/0003-4819-154-2-201101180-00012.CrossRefGoogle Scholar
  12. Chambers-Evans, J., & Carnevale, F. A. (2005). Dawning of awareness: The experience of surrogate decision making at the end of life. Journal of Clinical Ethics, 16(1), 28–45.Google Scholar
  13. Christakis, N. A., Smith, J. L., Parkes, C. M., & Lamont, E. B. (2000). Extent and determinants of error in doctors’ prognoses in terminally ill patients: Prospective cohort study. Commentary: Why do doctors overestimate? Commentary: Prognoses should be based on proved indices not intuition. BMJ, 320(7233), 469–473. doi: 10.1136/bmj.320.7233.469.CrossRefGoogle Scholar
  14. Clarke, C. M. (2000). Do parents or surrogates have the right to demand treatment deemed futile? An analysis of the case of Baby L. [Legal Cases Review]. Journal of Advanced Nursing, 32(3), 757–763.CrossRefGoogle Scholar
  15. Coleman, D. L., & Rosoff, P. M. (2013). The legal authority of mature minors to consent to general medical treatment. Pediatrics, 131(4), 786–793. doi: 10.1542/peds.2012-2470.CrossRefGoogle Scholar
  16. Cox, C. E., Lewis, C. L., Hanson, L. C., Hough, C. L., Kahn, J. M., White, D. B., et al. (2012). Development and pilot testing of a decision aid for surrogates of patients with prolonged mechanical ventilation. Critical Care Medicine, 40(8), 2327–2334. doi: 10.1097/CCM.0b013e3182536a63.CrossRefGoogle Scholar
  17. Cox, C. E., Martinu, T., Sathy, S. J., Clay, A. S., Chia, J., & Gray, A. L. (2009). Expectations and outcomes of prolonged mechanical ventilation. [research support, N.I.H., Extramural]. Critical Care Medicine, 37(11), 2888–2894. doi: 10.1097/CCM.0b013e3181ab86ed. (quiz 2904).CrossRefGoogle Scholar
  18. Davis, J. K. (2008). Futility, conscientious refusal, and who gets to decide. Journal of Medicine and Philosophy, 33(4), 356–373. doi: 10.1093/jmp/jhn019.CrossRefGoogle Scholar
  19. Dent v. West Virginia (1889). U.S. (Vol. 129, pp. 114): Supreme Court.Google Scholar
  20. Ditto, P. H., Danks, J. H., Smucker, W. D., Bookwala, J., Coppola, K. M., Dresser, R., et al. (2001). Advance directives as acts of communication: A randomized controlled trial. Archives of Internal Medicine, 161(3), 421–430. doi: 10.1001/archinte.161.3.421.CrossRefGoogle Scholar
  21. Dodek, P. M., Wong, H., Norena, M., Ayas, N., Reynolds, S. C., Keenan, S. P., et al. (2016). Moral distress in intensive care unit professionals is associated with profession, age, and years of experience. Journal of Critical Care, 31(1), 178–182. doi: 10.1016/j.jcrc.2015.10.011.CrossRefGoogle Scholar
  22. Edwards, S. J. L., Brown, P., Twyman, M. A., Christie, D., & Rakow, T. (2011). A qualitative investigation of selecting surrogate decision-makers. Journal of Medical Ethics. doi: 10.1136/jme.2010.037978.Google Scholar
  23. Fagerlin, A., Ditto, P. H., Danks, J. H., Houts, R. M., & Smucker, W. D. (2001). Projection in surrogate decisions about life-sustaining medical treatments. Health Psychology, 20(3), 166–175.CrossRefGoogle Scholar
  24. Fine, R. L. (2000). Medical futility and the Texas Advance Directives Act of 1999. Proceedings, 13(2), 144–147.Google Scholar
  25. Fine, R. L. (2009). Point: The Texas Advance Directives Act effectively and ethically resolves disputes about medical futility. Chest, 136(4), 963–967. doi: 10.1378/chest.09-1267.CrossRefGoogle Scholar
  26. Fine, R. L., & Mayo, T. W. (2003). Resolution of futility by due process: Early experience with the Texas Advance Directives Act. Annals of Internal Medicine, 138(9), 743–746.CrossRefGoogle Scholar
  27. Fins, J. J., Maltby, B. S., Friedmann, E., Greene, M. G., Norris, K., Adelman, R., et al. (2005). Contracts, covenants and advance care planning: An empirical study of the moral obligations of patient and proxy. Journal of Pain and Symptom Management, 29(1), 55–68. doi: 10.1016/j.jpainsymman.2004.07.004.CrossRefGoogle Scholar
  28. Frick, S., Uehlinger, D. E., & Zuercher Zenklusen, R. M. (2003). Medical futility: Predicting outcome of intensive care unit patients by nurses and doctors–A prospective comparative study. [Comparative Study Research Support, Non-U.S. Gov’t]. Critical Care Medicine, 31(2), 456–461. doi: 10.1097/01.CCM.0000049945.69373.7C.CrossRefGoogle Scholar
  29. Frost, D. W., Cook, D. J., Heyland, D. K., & Fowler, R. A. (2011). Patient and healthcare professional factors influencing end-of-life decision-making during critical illness: A systematic review. Critical Care Medicine, 39(5), 1174–1189. doi: 10.1097/CCM.1170b1013e31820eacf31822.CrossRefGoogle Scholar
  30. Gallagher, C., & Holmes, R. (2011). Handling cases of “medical futility”. HEC Forum. doi: 10.1007/s10730-011-9168-3.Google Scholar
  31. Handy, C. M., Sulmasy, D. P., Merkel, C. K., & Ury, W. A. (2008). The surrogate’s experience in authorizing a do not resuscitate order. Palliative & Supportive Care, 6(1), 13–19.CrossRefGoogle Scholar
  32. Henrich, N. J., Dodek, P. M., Alden, L., Keenan, S. P., Reynolds, S., & Rodney, P. (2016). Causes of moral distress in the intensive care unit: A qualitative study. Journal of Critical Care, 35, 57–62. doi: 10.1016/j.jcrc.2016.04.033.CrossRefGoogle Scholar
  33. High, D. M. (1990). Who will make health care decisions for me when I can’t? Journal of Aging and Health, 2(3), 291–309. doi: 10.1177/089826439000200301.CrossRefGoogle Scholar
  34. Hinkka, H., Kosunen, E., Metsanoja, R., Lammi, U. K., & Kellokumpu-Lehtinen, P. (2002). Factors affecting physicians’ decisions to forgo life-sustaining treatments in terminal care. Journal of Medical Ethics, 28(2), 109–114. doi: 10.1136/jme.28.2.109.CrossRefGoogle Scholar
  35. Hirni, K., & Carter, B. (2015). Hearing others’ perspectives when we hear, “do everything!”. JAMA Pediatrics, 169(5), 423–424. doi: 10.1001/jamapediatrics.2014.3699.CrossRefGoogle Scholar
  36. Hodgson, C. S., Teherani, A., Gough, H. G., Bradley, P., & Papadakis, M. A. (2007). The relationship between measures of unprofessional behavior during medical school and indices on the California Psychological Inventory. Academic Medicine, 82(10 Suppl), S4–S7. doi: 10.1097/ACM.0b013e318140047f00001888-200710001-00002.CrossRefGoogle Scholar
  37. Hopp, F. P. (2000). Preferences for surrogate decision makers, informal communication, and advance directives among community-dwelling elders results from a national study. The Gerontologist, 40(4), 449–457.CrossRefGoogle Scholar
  38. Investigators, S. P., Connors, A. F., Dawson, N. V., Desbiens, N. A., Fulkerson, W. J., Goldman, L., et al. (1995). A controlled trial to improve care for seriously ill hospitalized patients. JAMA: The Journal of the American Medical Association, 274(20), 1591–1598. doi: 10.1001/jama.1995.03530200027032.CrossRefGoogle Scholar
  39. Kahane, G., & Savulescu, J. (2009). Brain damage and the moral significance of consciousness. Journal of Medicine and Philosophy, 34(1), 6–26. doi: 10.1093/jmp/jhn038.Google Scholar
  40. Kattan, M. W., O’Rourke, C., Yu, C., & Chagin, K. (2015). The wisdom of crowds of doctors: Their average predictions outperform their individual ones. Medical Decision Making. doi: 10.1177/0272989x15581615.Google Scholar
  41. Kelly, B., Rid, A., & Wendler, D. (2012). Systematic review: Individuals’ goals for surrogate decision-making. Journal of the American Geriatrics Society, 60(5), 884–895. doi: 10.1111/j.1532-5415.2012.03937.x.CrossRefGoogle Scholar
  42. Kopelman, L. M. (2007). The best interests standard for incompetent or incapacitated persons of all ages. The Journal of Law, Medicine & Ethics, 35(1), 187–196.CrossRefGoogle Scholar
  43. LaFollette, H. (1980). Licensing parents. Philosophy & Public Affairs, 9(2), 182–197.Google Scholar
  44. LaFollette, H. (2010). Licensing parents revisited. Journal of Applied Philosophy, 27(4), 327–343. doi: 10.1111/j.1468-5930.2010.00497.x.CrossRefGoogle Scholar
  45. Marks, M. A. Z., & Arkes, H. R. (2008). Patient and surrogate disagreement in end-of-life decisions: Can surrogates accurately predict patients’ preferences? Medical Decision Making, 28(4), 524–531. doi: 10.1177/0272989x08315244.CrossRefGoogle Scholar
  46. Meadow, W., Pohlman, A., Frain, L., Ren, Y., Kress, J. P., Teuteberg, W., et al. (2011). Power and limitations of daily prognostications of death in the medical intensive care unit. Critical Care Medicine, 39(3), 474–479. doi: 10.1097/CCM.0b013e318205df9b.CrossRefGoogle Scholar
  47. Melcher, R. K. (2012). There Ain’t No End for the “Wicked”: Implications of and Recommendations for § 4248 of the Adam Walsh Act After United States v. Comstock. Iowa Law Journal, 97, 629–664.Google Scholar
  48. Miles, S. H. (1990). Why a hospital seeks to discontinue care against family wishes. Law, Medicine & Health Care: A Publication of the American Society of Law & Medicine, 18(4), 424–425.Google Scholar
  49. Miles, S. H. (1991a). Autonomy’s responsibility: A gloss on the Wanglie affair. Health Progress, 72(10), 30–31.Google Scholar
  50. Miles, S. H. (1991b). Legal procedures in Wanglie: A two-step, not a sidestep. Journal of Clinical Ethics, 2(4), 285–286.Google Scholar
  51. Miles, S. H. (1992). Interpersonal issues in the Wanglie case. Kennedy Institute of Ethics Journal, 2(1), 61–72.CrossRefGoogle Scholar
  52. Moorman, S. M., & Carr, D. (2008). Spouses’ effectiveness as end-of-life health care surrogates: Accuracy, uncertainty, and errors of overtreatment or undertreatment. Gerontologist, 48(6), 811–819.CrossRefGoogle Scholar
  53. Ostrom, C. M. (November 29, 2007) Mount Vernon leukemia patient, 14, dies after rejecting transfusions. The Seattle Times.Google Scholar
  54. Ouimet, S., Kavanagh, B. P., Gottfried, S. B., & Skrobik, Y. (2007). Incidence, risk factors and consequences of ICU delirium. Intensive Care Medicine, 33(1), 66–73. doi: 10.1007/s00134-006-0399-8.CrossRefGoogle Scholar
  55. Papadakis, M. A., Teherani, A., Banach, M. A., Knettler, T. R., Rattner, S. L., Stern, D. T., et al. (2005). Disciplinary action by medical boards and prior behavior in medical school. New England Journal of Medicine, 353(25), 2673–2682.CrossRefGoogle Scholar
  56. Parks, S. M., Winter, L., Santana, A. J., Parker, B., Diamond, J. J., Rose, M., et al. (2011). Family factors in end-of-life decision-making: Family conflict and proxy relationship. Journal of Palliative Medicine, 14(2), 179–184. doi: 10.1089/jpm.2010.0353.CrossRefGoogle Scholar
  57. Pope, T. M. (2010). Surrogate selection: An increasingly viable, but limited, solution to intractable futility disputes. Saint Louis University Journal of Health Law & Policy, 3, 183–252.Google Scholar
  58. Poses, R. M., McClish, D. K., Bekes, C., Scott, W. E., & Morley, J. N. (1991). Ego bias, reverse ego bias, and physicians’ prognostic. Critical Care Medicine, 19(12), 1533–1539.CrossRefGoogle Scholar
  59. Raymont, V., Bingley, W., Buchanan, A., David, A. S., Hayward, P., Wessely, S., et al. (2004). Prevalence of mental incapacity in medical inpatients and associated risk factors: Cross-sectional study. The Lancet, 364(9443), 1421–1427.CrossRefGoogle Scholar
  60. Raznahan, A., Shaw, P., Lalonde, F., Stockman, M., Wallace, G. L., Greenstein, D., et al. (2011). How does your cortex grow? The Journal of Neuroscience, 31(19), 7174–7177. doi: 10.1523/jneurosci.0054-11.2011.CrossRefGoogle Scholar
  61. Robson, N., & Rew, D. (2010). Collective wisdom and decision making in surgical oncology. European Journal of Surgical Oncology (EJSO), 36(3), 230–236. doi: 10.1016/j.ejso.2010.01.002.CrossRefGoogle Scholar
  62. Rosoff, P. M. (2013). Institutional futility policies are inherently unfair. HEC Forum, 25(3), 191–209. doi: 10.1097/01.phm.0000233181.34999.3d.CrossRefGoogle Scholar
  63. Rosoff, P. M. (2015). TADA is still unfair. The American Journal of Bioethics, 15(8), 56–58. doi: 10.1080/15265161.2015.1043406.CrossRefGoogle Scholar
  64. Rosoff, P. M., & Leong, K. M. (2015). An ethical and legal framework for physicians as surrogate decision-makers for their patients. The Journal of Law, Medicine & Ethics, 43(4), 857–877. doi: 10.1111/jlme.12325.Google Scholar
  65. Rucker, B., & Browning, D. M. (2015). Practicing end-of-life conversations: Physician communication training program in palliative care. Journal of Social Work in End-of-Life & Palliative Care, 11(2), 132–146. doi: 10.1080/15524256.2015.1074140.CrossRefGoogle Scholar
  66. Schneiderman, L. (2011). Defining medical futility and improving medical care. Journal of Bioethical Inquiry, 8(2), 123–131. doi: 10.1007/s11673-011-9293-3.CrossRefGoogle Scholar
  67. Shalowitz, D. I., Garrett-Mayer, E., & Wendler, D. (2006). The accuracy of surrogate decision makers: A systematic review. Archives of Internal Medicine, 166(5), 493–497.CrossRefGoogle Scholar
  68. Shaw, P., Kabani, N. J., Lerch, J. P., Eckstrand, K., Lenroot, R., Gogtay, N., et al. (2008). Neurodevelopmental trajectories of the human cerebral cortex. The Journal of Neuroscience, 28(14), 3586–3594. doi: 10.1523/jneurosci.5309-07.2008.CrossRefGoogle Scholar
  69. Silveira, M. J., Kim, S. Y. H., & Langa, K. M. (2010). Advance directives and outcomes of surrogate decision making before death. New England Journal of Medicine, 362(13), 1211–1218. doi: 10.1056/NEJMsa0907901.CrossRefGoogle Scholar
  70. Siontis, G. C. M., Tzoulaki, I., & Ioannidis, J. P. A. (2011). Predicting death: An empirical evaluation of predictive tools for mortality. Archives of Internal Medicine, 171(19), 1721–1726. doi: 10.1001/archinternmed.2011.334.CrossRefGoogle Scholar
  71. Smith, M. L., Gremillion, G., Slomka, J., & Warneke, C. L. (2007). Texas hospitals’ experience with the Texas Advance Directives Act. Critical Care Medicine, 35(5), 1271–1276.CrossRefGoogle Scholar
  72. Smucker, J. D., Rhee, J. M., Singh, K., Yoon, S. T., & Heller, J. G. (2006). Increased swelling complications associated with off-label usage of rhBMP-2 in the anterior cervical spine. Spine, 31(24), 2813–2819.CrossRefGoogle Scholar
  73. Snyder, E. A., Caprio, A. J., Wessell, K., Lin, F. C., & Hanson, L. C. (2013). Impact of a decision aid on surrogate decision-makers’ perceptions of feeding options for patients with dementia. Journal of the American Medical Directors Association, 14(2), 114–118. doi: 10.1016/j.jamda.2012.10.011.CrossRefGoogle Scholar
  74. Sudore, R. L., & Fried, T. R. (2010). Redefining the “planning” in advance care planning: Preparing for end-of-life decision making. Annals of Internal Medicine, 153(4), 256–261.CrossRefGoogle Scholar
  75. Suhl, J., Simons, P., Reedy, T., & Garrick, T. (1994). Myth of substituted judgment: Surrogate decision making regarding life support is unreliable. Archives of Internal Medicine, 154(1), 90–96. doi: 10.1001/archinte.1994.00420010122014.CrossRefGoogle Scholar
  76. Teno, J. M., Gozalo, P. L., Bynum, J. W., et al. (2013). Change in end-of-life care for medicare beneficiaries: Site of death, place of care, and health care transitions in 2000, 2005, and 2009. JAMA, 309(5), 470–477. doi: 10.1001/jama.2012.207624.CrossRefGoogle Scholar
  77. Texas Advanced Directives Act (1999) from, see § 166.046-§ 166.052.
  78. The President’s Commision. (1983). Research. Deciding to forego life-sustaining treatment. Washington, D.C.: The President’s Commision.Google Scholar
  79. Torke, A. M., Alexander, G. C., Lantos, J., & Siegler, M. (2007). The physician–surrogate relationship. Archives of Internal Medicine, 167(11), 1117–1121. doi: 10.1001/archinte.167.11.1117.CrossRefGoogle Scholar
  80. Torke, A. M., Sachs, G. A., Helft, P. R., et al. (2014). Scope and outcomes of surrogate decision making among hospitalized older adults. JAMA Internal Medicine, 174(3), 370–377. doi: 10.1001/jamainternmed.2013.13315.CrossRefGoogle Scholar
  81. Truog, R. D. (2007). Tackling medical futility in Texas. New England Journal of Medicine, 357(1), 1–3. doi: 10.1056/NEJMp078109.CrossRefGoogle Scholar
  82. Truog, R. D. (2009). Counterpoint: The texas advance directives act is ethically flawed. Chest, 136(4), 968–971. doi: 10.1378/chest.09-1269.CrossRefGoogle Scholar
  83. United States v. Comstock (2010). (Vol. 560, pp. 126): U.S. Supreme Court.Google Scholar
  84. Varma, S., & Wendler, D. (2007). Medical decision making for patients without surrogates. Archives of Internal Medicine, 167(16), 1711–1715.CrossRefGoogle Scholar
  85. Wendler, D., & Rid, A. (2011). Systematic review: The effect on surrogates of making treatment decisions for others. Annals of Internal Medicine, 154(5), 336–346. doi: 10.1059/0003-4819-154-5-201103010-00008.CrossRefGoogle Scholar
  86. White, D. B., Curtis, J. R., Lo, B., & Luce, J. M. (2006). Decisions to limit life-sustaining treatment for critically ill patients who lack both decision-making capacity and surrogate decision-makers. Critical Care Medicine, 34(8), 2053–2059.CrossRefGoogle Scholar
  87. White, D. B., & Pope, T. M. (2012). The courts, futility, and the ends of medicine. JAMA: The Journal of the American Medical Association, 307(2), 151–152. doi: 10.1001/jama.2011.1990.CrossRefGoogle Scholar
  88. Zettel-Watson, L., Ditto, P. H., Danks, J. H., & Smucker, W. D. (2008). Actual and perceived gender differences in the accuracy of surrogate decisions about life-sustaining medical treatment among older spouses. Death Studies, 32(3), 273–290.CrossRefGoogle Scholar
  89. Zier, L. S., Burack, J. H., Micco, G., Chipman, A. K., Frank, J. A., Luce, J. M., et al. (2008). Doubt and belief in physicians’ ability to prognosticate during critical illness: The perspective of surrogate decision makers. Critical Care Medicine, 36(8), 2341–2347. doi: 10.1097/CCM.0b013e318180ddf9.CrossRefGoogle Scholar
  90. Zier, L. S., Burack, J. H., Micco, G., Chipman, A. K., Frank, J. A., & White, D. B. (2009). Surrogate decision makers’ responses to physicians’ predictions of medical futility. Chest, 136(1), 110–117. doi: 10.1378/chest.08-2753.CrossRefGoogle Scholar
  91. Zier, L. S., Sottile, P. D., Hong, S. Y., Weissfield, L. A., & White, D. B. (2012). Surrogate decision makers’ interpretation of prognostic information: A mixed-methods study. Annals of Internal Medicine, 156(5), 360–366. doi: 10.7326/0003-4819-156-5-201203060-00008.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2016

Authors and Affiliations

  1. 1.Trent Center for Bioethics, Humanities and History of Medicine, Duke University Medical CenterDurhamUSA

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