Additional Ethical, Legal, and Social Considerations for Clinicians Navigating a Difficult Relationship with a Patient’s Surrogate Decision-Maker

Abstract

Abstract This commentary highlights additional considerations for clinicians encountering substitute decision-makers who want to make different decisions than the healthcare or ethics team thinks an incapacitated patient would have made. This commentary first focuses on how evolving understandings of decision-making capacity and the increased availability of formal supported decision-making matter for cases like Mr. Andrews. This commentary then discusses relational autonomy in end-of-life decision-making and how patients may prioritize their family’s needs over their own medical preferences. This commentary then concludes by discussing other legal implications, namely the potential abuse of legal processes that facilitate decision-making on behalf of unrepresented patients and corresponding concern that physician paternalism is being masked as consideration for patient autonomy.