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Moral justifications for surrogate decision making in the intensive care unit: Implications and limitations

Arnold, Robert M. MD; Kellum, John MD

doi: 10.1097/01.CCM.0000065123.23736.12
Scientific Reviews

Because patients are often unable to participate in the end-of-life decision making, caregivers turn to close family members to participate in discussions regarding care in the intensive care unit. This article describes the moral justifications for families being given considerable decision-making authority. However, embedded within these justifications are also some limitations to surrogate decision making. Rather than attempt to dogmatically resolve these thorny cases regarding a surrogate’s request for what healthcare providers believe are unreasonable requests, we believe more attention should be paid to how healthcare providers and intensive care units can promote a surrogate’s ability to make ethical decisions. We end by offering a number of specific suggestions for improving communication with surrogates.

From the Department of Medicine, Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, Center for Bioethics and Health Law, Institute for Performance Improvement, University of Pittsburgh Cancer Institute (RMA), and the Departments of Critical Care Medicine and Medicine, CRISMA Laboratory (JK), University of Pittsburgh School of Medicine, Pittsburgh, PA.

Supported, in part, by the Project on Death in America Faculty Scholars Program, the Greenwall Foundation, Ladies Hospital Aid Society of Western Pennsylvania, the International Union Against Cancer (UICC) Yamagiwa-Yoshida Memorial International Cancer Study Grant, the LAS Trust Foundation (R. M. Arnold), and the Leo H. Criep Patient Care.

Address requests for reprints to: Robert M. Arnold, MD, Department of Medicine, 200 Lothrop Street, Pittsburgh, PA 15213.

More attention should be paid to how healthcare providers and intensive care units can promote a surrogate’s ability to make ethical decisions.

© 2003 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins