Capacity for Preferences: Respecting Patients with Compromised Decision-Making.

Area of Science:

• Bioethics
• Clinical Ethics
• Medical Decision-Making

Background:

• Standard US clinical ethics practice involves surrogate decision-makers for patients lacking capacity.
• Surrogates aim for substituted judgment or best interests when patient preferences are unclear.
• Existing supported decision-making models often prioritize surrogate/team-determined best interests.

Purpose of the Study:

• To advocate for incorporating patient preferences as an additional guidance source in clinical decisions for incapacitated patients.
• To explore the ethical grounding for valuing patient preferences beyond best-interests or surrogate autonomy.
• To highlight the implications for treatment decisions involving vulnerable patients.

Main Methods:

• Ethical analysis and argumentation.
• Review of existing supported/assisted/guided decision-making models.
• Philosophical grounding in values of liberty and respect for persons.

Main Results:

• Current practices may not fully capture or prioritize patient preferences.
• Patient preferences offer valuable input, even with surrogate involvement.
• The moral basis for valuing patient preferences lies in liberty and respect for persons.

Conclusions:

• Patient preferences should be actively solicited and considered, not solely filtered through surrogates.
• Ethical justification for using patient preferences extends beyond promoting best interests or surrogate autonomy.
• Prioritizing patient preferences upholds fundamental ethical values for vulnerable individuals.