title: At a threshold: making decisions when you don't have all the answers.
abstract: Many people who sustain a brain injury also lose decisional capacity. They need someone who will be a partner with clinicians in making decisions on their behalf. This article reviews ethical aspects of decision making; the legal foundation in the United States for surrogate decision making; the experience of surrogate decision making on behalf of people who have a brain injury, including similarities and differences between such decision making for the dying and for those who have a brain injury; and ways to approach intractable disagreements between surrogate or family and clinicians. It provides guidelines for clinicians and surrogates and suggests topics for research. Two people who have suffered a brain injury and the spouse of one are coauthors.
authors.affiliation: Department of Religion, Health, and Human Values, Rush University Medical Center, 1018A Academic Center, 600 S. Paulina Street, Chicago IL 60612, USA. russell_burck@rush.edu <russell_burck@rush.edu>
authors.forename: J Russell
authors.initials: JR
authors.lastname: Burck
authors.forename: Marvel
authors.initials: M
authors.lastname: Vena
authors.forename: Mark
authors.initials: M
authors.lastname: Jolicoeur
authors.forename: Laurie Edge
authors.initials: LE
authors.lastname: Jolicoeur
mesh_terms: D001930:Brain Injuries / Q000628:therapy*; D003142:Communication; D003657:Decision Making; D005190:Family; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D007258:Informed Consent / Q000941:ethics; D008297:Male; D010344:Patient Advocacy / Q000941:ethics / Q000523:psychology*