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• W2040609907 abstract "I read with interest the report in CHEST (July 2009) by Zier et al1Zier LS Burack JH Micco G Chipman AK Frank JA White DB Surrogate decision makers' responses to physicians' predictions of medical futility.Chest. 2009; 136: 110-117Abstract Full Text Full Text PDF PubMed Scopus (73) Google Scholar in which they examine surrogate decision makers' responses to physicians' predictions of medical futility. Futility disputes cause significant staff distress and consume prodigious palliative care and ethics consultation resources. Fortunately, most futility disputes are resolved collaboratively by providers and surrogates.2Pope TM Medical futility statutes: no safe harbor to unilaterally refuse life-sustaining medical treatment.Tenn Law Rev. 2007; 71: 1-81Google Scholar And increasingly, with findings like those offered by Zier et al,1Zier LS Burack JH Micco G Chipman AK Frank JA White DB Surrogate decision makers' responses to physicians' predictions of medical futility.Chest. 2009; 136: 110-117Abstract Full Text Full Text PDF PubMed Scopus (73) Google Scholar the already high rate of resolution and consensus can be further improved. With a better understanding of surrogates' motivations and rationales for resisting provider recommendations to discontinue life support, the development of empirically derived interventions can be enhanced. Process-based approaches can then incorporate targeted interventions and deploy them according to the precise basis for surrogate dissent. Unfortunately, Zier et al1Zier LS Burack JH Micco G Chipman AK Frank JA White DB Surrogate decision makers' responses to physicians' predictions of medical futility.Chest. 2009; 136: 110-117Abstract Full Text Full Text PDF PubMed Scopus (73) Google Scholar fail to recognize some rather significant implications of their key finding that “surrogates with religious objections to the futility rationale were more adamant about continuing life support.” Prima facie, a surrogate's own religious beliefs are wholly irrelevant to the treatment decision. Surrogates must exercise “substituted judgment” and make the medical choice that the patient, if competent, would have made. If there is insufficient evidence of what the patient would have wanted, then the surrogate must act in the patient's “best interests.”3Meisel A Cerminara KL The Right to Die: The Law of End-of-Life Decisionmaking. 3rd ed. Aspen Publishers, New York, NY2009Google Scholar But whichever standard is employed, the surrogate's decision must reflect only patient-centered considerations. Zier et al1Zier LS Burack JH Micco G Chipman AK Frank JA White DB Surrogate decision makers' responses to physicians' predictions of medical futility.Chest. 2009; 136: 110-117Abstract Full Text Full Text PDF PubMed Scopus (73) Google Scholar ask “whether it is appropriate to override a surrogate's deeply held religious belief.” The answer to this question depends on data that Zier et al1Zier LS Burack JH Micco G Chipman AK Frank JA White DB Surrogate decision makers' responses to physicians' predictions of medical futility.Chest. 2009; 136: 110-117Abstract Full Text Full Text PDF PubMed Scopus (73) Google Scholar did not collect or report. Specifically, does the patient share the surrogate's religious beliefs?4HE v A NHS Hosp Trust. EWHC [England and Wales High Court of Justice] 1017 (Fam.) (2003)Google Scholar Did the patient specifically grant the surrogate unusually wide discretion to consider her preferences as not binding but merely informative?5Berger JT DeRenzo EG Schwartz J Surrogate decision making: reconciling ethical theory and clinical practice.Ann Intern Med. 2008; 149: 48-53Crossref PubMed Scopus (129) Google Scholar To be sure, it is controversial whether a provider should override a patient's own deeply held religious belief. But a surrogate stands in the shoes of the patient. Without evidence of patient authorization, it is not only permissible, but mandatory, that the surrogate's deeply held religious beliefs be excluded and eliminated from the decision-making process. Resolving Conflicts With Surrogate Decision Makers: ResponseCHESTVol. 137Issue 1PreviewWe thank Dr Pope for initiating a discussion about the normative ethical implications of our study recently published in CHEST (July 2009),1 which space limits did not allow us to pursue. He correctly points out that the ethical underpinnings of surrogate decision making require surrogates to set aside their own hopes and preferences for the patient and instead make decisions based on the substituted judgment or the best-interest standards. The aim of the study was not to examine this issue, and consequently our data are not helpful on this point. Full-Text PDF" @default.
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• W2040609907 title "Resolving Conflicts With Surrogate Decision Makers" @default.
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• W2040609907 doi "https://doi.org/10.1378/chest.09-1637" @default.
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