This chapter considers the role of law in the ICU and presents the legal and bioethical scripts for surrogate decision making. It describes legal provisions for advance directives that specify the patient’s wishes and/or decision maker and the criteria for the selection of a default surrogate when no decision maker was appointed. The chapter reviews the bioethical standards which surrogates should follow when deciding for another—beginning with the patient’s explicit instructions and, when they are unknown, substituted judgments of the patient’s wishes, followed by the patient’s best interests—as well as the evidentiary rules to guide surrogate judgments. Surrogates encounter many difficulties following these scripts in the real world, even as so many families and health care providers don’t even know that they exist. One of those difficulties results from the impossibility of truly knowing another’s wishes, another from conflicts of interest at the bedside which are inevitable when loved ones, with the most to gain or lose, are entrusted with life-and-death decisions. Yet another reflects the heuristic and cognitive biases that compromise the judgments of physicians and decision makers alike. The chapter concludes by reviewing the challenges of implementing law at the bedside.
Chicago Scholarship Online requires a subscription or purchase to access the full text of books within the service. Public users can however freely search the site and view the abstracts and keywords for each book and chapter.
If you think you should have access to this title, please contact your librarian.
To troubleshoot, please check our FAQs, and if you can't find the answer there, please contact us.