Bioethics Blogs

Health Care Decision Making for Unbefriended, Incapacitated Adults: A Value-Committed Policy Transfer Analysis

Despite the scope and prevalence of the problem, there is not much literature
addressing the problem of incapacitated unrepresented patients.  One new 21-page article nicely summarized the issues.

This article then zeroes in to assess two innovative approaches.  Texas permits clergy to serve as default surrogates.  Florida permits social workers.

The authors write:  “These mechanisms allow for surrogate or proxy consent for medical treatment not otherwise covered by emergency consent procedures. Moreover, this mechanism supports timely health care decisions for patients who otherwise are subject to institutional ad hoc approaches to consent for non-emergent treatment or judicial processes such as guardianship or emergency treatment orders.”

“Although of benefit to the patient, default surrogate or proxy mechanisms for unbefriended, incapacitated patients carry implicit benefits in the form of economic gains to health care organizations that come from facilitating timely health care decisions. These gains may come in the form of expediting  hospital discharges. . . .  In essence, the mechanisms to facilitate health care decision making for unbefriended, incapacitated patents function as a double-edged sword: vulnerable patients benefit from a health care agent to facilitate medical care decision making and entities (e.g., for-profit hospitals, state resources) realize economic gains from alternatives to guardianship.”

“Therefore, it is imperative to acknowledge these competing interests when surrogate and proxy health care decision makers for unbefriended, incapacitated adults are selected such that competing interests are  minimized.”

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.