Reconceptualizing the Experience of Surrogate Decision Making: Reports vs Genuine Decisions

The authors of this paper are making a valuable contribution to the ethical debate on medical decision making for incapacitated patients by distinguishing between the role of genuine ‘surrogate decision making’ and that of ‘passing on’ or ‘reporting’ known patient wishes. The authors point out that in the latter situation there is no decision for surrogates to make (since any decision has already been made by the patient) and as the surrogate’s role in this situation is merely to report patient wishes it should be reconceptualised to reflect this. This argument is backed up by empirical research which shows that surrogates in this position experience their role more as a reporter of wishes rather than a decision maker for the incapacitated patient. The call to reconceptualise the ‘decision making’ role as a ‘reporting’ role, when appropriate, is to be applauded - not only because it better reflects the role as experienced by surrogates in this position but also because it relieves surrogates of the psychosocial and moral burdens that come with decision making. This research is an example of the important contribution that empirical research can make to ethical debate. It brings some humanity into what can otherwise be abstract and cold ethical reasoning. Such research moves us away from the increasingly unsustainable position that abstract reasoning has led us too, a default setting is of ‘do-everything-medically- possible’, and will hopefully lead us towards a more sustainable position where surrogates can pass on known patient wishes without having to bear the moral burden associated with the ‘decision maker’ label. Yay for humanity.

Competing interests:   None declared