When previously expressed wishes conflict with best interests

Area of Science:

• Medical Ethics
• Clinical Decision-Making
• Patient Advocacy

Background:

• Advance directives are increasingly used to guide medical care for incapacitated patients.
• Conflicts arise when advance directives clash with perceived patient best interests, burdening physicians and surrogates.

Observation:

• Advance directives can complicate surrogate decision-making, creating ethical challenges.
• Existing guidance for resolving these conflicts is limited.

Findings:

• A 5-question framework is proposed to navigate conflicts between advance directives and patient best interests.
• The framework assesses emergency status, benefit-burden analysis, directive relevance, patient-granted leeway, and surrogate representation.

Implications:

• This framework offers practical guidance for resolving complex ethical dilemmas in surrogate decision-making.
• It aids physicians and surrogates in upholding patient values while addressing clinical realities.