Time and Language in Bioethics: When Patient and Proxy Appear to Disagree
McClung, John Arthur
Journal of Clinical Ethics. 1995 Spring; 6(1): 39-43.
The increasing use of proxy documents and durable powers of attorney as a way to assist surrogates in their decision making for patients without capacity has led to some interesting examples of real or apparent conflict between the patients' wishes and their surrogates' requests. Both a statistical and an anecdotal literature have evolved detailing the degree to which patients and their designated surrogates often disagree about the care appropriate in a given clinical setting. The case below demonstrates how an apparent misunderstanding can derive from a directive whose intended meaning may not apply within a specific time and set of circumstances. It raises the important question of whether a patient's wishes can be understood without examining the context in which they are expressed. In so doing, it further serves as a guide for avoiding similar difficulties in similar situations.
Advance Directives; Allowing to Die; Bioethics; Case Studies; Clinical Ethics; Communication; Competence; Comprehension; Critically Ill; Coma; Consent; Consultation; Decision Making; Dissent; Ethics; Family Members; Informed Consent; Life; Literature; Patient Care; Patients; Prognosis; Prolongation of Life; Proxy; Referral and Consultation; Resuscitation; Resuscitation Orders; Third Party Consent; Treatment Refusal; Uncertainty;
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