The role of surrogate decision-makers is to make decisions consistent with the patient’s previously expressed wishes, written documents, and values. But that is not what usually happens. Lack of communication between the patient and the surrogate and/or between the surrogate and the medical team is the biggest obstacle.
Federal law requires hospitals to inform patients of the need to choose a surrogate. However, many institutions perform this task poorly, due in part to a lack of clear policies, proper training, and other support. There are a few ways the ethics team can help.
A patient’s capacity to give informed consent or to leave the emergency department against medical advice is a topic of great relevance to emergency clinicians. This article discusses the difference between competence and capacity and highlights the four essential elements involved in the assessment of a patient’s capacity.
A multicenter, one-day prevalence, prospective, observational, double-blind study in 19 ICUs revealed that the decisionmaking capacity of ICU patients was widely overestimated by all clinicians as compared with a capacity score measured by the Mini-Mental Status Examination and the Aid to Capacity Evaluation.