Navigating Ethical Conflicts Between Advance Directives and Surrogate Decision-Makers' Interpretations of Patient Wishes.
There is little guidance on what clinicians should do when advance directives (or living wills, specifically) are challenged, particularly when surrogate decision-makers' interpretations of patients' wishes conflict with the living will. In our commentary, we make a controversial argument suggesting that overriding living wills can be ethically preferable to the alternative of strictly adhering to them. We propose four ethical considerations for determining whether it is ethically supportable to override living wills.
Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX. Electronic address: crbruce@bcm.edu.
Courtenay R
CR
Bruce
Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX.
Trevor
T
Bibler
Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX; Department of Medicine, Baylor College of Medicine, Houston, TX; Bioethics Program, Houston Methodist Hospital, Houston, TX.
Andrew M
AM
Childress
Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX; Bioethics Program, Houston Methodist Hospital, Houston, TX.
Ashley L
AL
Stephens
Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX; Bioethics Program, Houston Methodist Hospital, Houston, TX.
Adam M
AM
Pena
Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX; Department of Medicine, Baylor College of Medicine, Houston, TX; Section of Emergency Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX; Bioethics Program, Houston Methodist Hospital, Houston, TX.
Nathan G
NG
Allen
D016223:Advance Directives / Q000941:ethics*; D003657:Decision Making; D006801:Humans; D016224:Living Wills / Q000941:ethics*; D009014:Morals; D013727:Terminal Care / Q000941:ethics*
commentary; critical care; end of life; medical ethics; quality of life