Patients who lack capacity and lack surrogates: can they enroll in hospice?
Patients who lack capacity and lack surrogates are among the most vulnerable patients we care for in palliative care. In the case we present here, we have considered how to make end-of-life decisions for a patient who lacks both capacity and surrogates, who has a terminal illness, and who is not a candidate for disease-modifying treatments. We first define and characterize this population of patients through a review of the literature and then explore some decision-making quandaries that are encountered at the end of life. Finally, we make recommendations on how best to proceed with decision making for this vulnerable population.
Union Graduate College-Icahn School of Medicine at Mount Sinai, Schenectady, New York, USA; Georgetown University, Washington, DC, USA. Electronic address: andem.effiong@gmail.com.
Andem
A
Effiong
Division of General Medical Disciplines, Stanford University School of Medicine, Stanford, California, USA.
Stephanie
S
Harman
D032722:Advance Care Planning / Q000941:ethics*; D000368:Aged; D003657:Decision Making / Q000941:ethics*; D017051:Hospice Care; D006801:Humans; D008297:Male; D016743:Mental Competency; D010166:Palliative Care / Q000941:ethics*; D010343:Patient Admission; D010358:Patient Participation; D010819:Physician's Role; D010817:Physician-Patient Relations / Q000941:ethics; D019727:Proxy; D012017:Referral and Consultation / Q000941:ethics; D014481:United States; D035862:Vulnerable Populations
Capacity; advance care planning; end of life; hospice; palliative care; shared decision making; unbefriended