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

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.