The Incapacitated Surrogate: What is the Consultation-Liaison Psychiatrist's Role?

When a patient is found to be lacking capacity to make a medical decision, the medical team is advised to turn to the patient's most appropriate surrogate decision maker (hereafter, surrogate) to make a choice on behalf of the patient. The assumption made by the medical team is that the surrogate will have the capacity to make appropriate medical decisions on behalf of the patient. At times though, the capacity of the surrogate himself may be called into question, leading to uncertainty in terms of how best to proceed in the care of the patient. Consultation-liaison psychiatrists are commonly consulted to assess a patient's capacity to make a particular medical decision, but their role assisting in cases of incapacitated surrogates is less clear.

In this article, we summarize the existing literature and current state laws regarding incapacitated surrogates and propose guidelines for the role the consultation-liaison psychiatrist can take when the surrogate may be incapacitated.