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Speaking for the DyingLife-and-Death Decisions in Intensive Care$
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Susan P. Shapiro

Print publication date: 2019

Print ISBN-13: 9780226615608

Published to Chicago Scholarship Online: January 2020

DOI: 10.7208/chicago/9780226615882.001.0001

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PRINTED FROM CHICAGO SCHOLARSHIP ONLINE (www.chicago.universitypressscholarship.com). (c) Copyright University of Chicago Press, 2022. All Rights Reserved. An individual user may print out a PDF of a single chapter of a monograph in CHSO for personal use.date: 25 June 2022

Decision-Making Scripts

Decision-Making Scripts

Chapter:
(p.134) Six Decision-Making Scripts
Source:
Speaking for the Dying
Author(s):

Susan P. Shapiro

Publisher:
University of Chicago Press
DOI:10.7208/chicago/9780226615882.003.0006

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.

Keywords:   Law at the bedside, Advance directives, Default surrogate, Decision-making standards, Patient wishes, Substituted judgment, Best interest, Conflict of interest, Heuristic and cognitive bias

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