Chapter

Advance Care Planning and Surrogate Decision-Making

Robert C. Macauley

in Ethics in Palliative Care

Published on behalf of Oxford University Press

Published in print March 2018 | ISBN: 9780199313945
Published online April 2018 | e-ISBN: 9780190652357 | DOI: https://dx.doi.org/10.1093/med/9780199313945.003.0003
Advance Care Planning and Surrogate Decision-Making

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Adult patients are presumed to possess decision-making capacity, but when they are unable to make their own decisions—which is especially frequent in the context of serious illness—ideally a surrogate decision-maker will be able to determine what the patient would have wanted (i.e., substituted judgment). Only when this is not possible is it necessary to fall back on what seems to be in the patient’s best interests. To foster patient autonomy, goals and values should be identified and documented in advance, such as in an advance directive, as well as a surrogate decision-maker named. This helps guide the medical team in critical and often uncertain times, given the challenges in accurate prognostication (which are lessening with the advent of evidence-based tools).

Chapter.  23423 words.  Illustrated.

Subjects: Palliative Medicine ; Patient Care and End-of-Life Decision Making ; Medical Ethics

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