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Locating and Identifying Third-Party Decision-Makers.

Jacob M Appel1

  • 1Dr. Appel is Associate Professor of Psychiatry and Medical Education, Director of Ethics Education in Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY. jacob.appel@mssm.edu.

The Journal of the American Academy of Psychiatry and the Law
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PubMed
Summary
This summary is machine-generated.

Determining if a patient is unbefriended is crucial for surrogate decision-making. This study analyzes state laws and proposes a clinical approach for identifying unbefriended patients needing healthcare decisions.

Keywords:
capacityhealth care proxiesstandard of caresurrogate decision-makingunbefriended adults

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Area of Science:

  • Medical Ethics
  • Health Law
  • Patient Advocacy

Background:

  • Third-party decision-makers (proxies, surrogates) are common for incapacitated patients in the U.S.
  • A growing challenge involves making decisions for unbefriended patients lacking identified surrogates.
  • Limited attention has been given to defining 'unbefriended' and the process for identifying such patients.

Purpose of the Study:

  • To examine how clinicians determine if a patient is unbefriended.
  • To analyze state statutory variations in the effort required to find decision-makers and the certainty needed regarding surrogate identity.
  • To propose a practical, context-based approach for clinical decision-making regarding unbefriended patients.

Main Methods:

  • Compilation and tabular presentation of state statutory language concerning the identification of unbefriended patients and surrogate decision-makers.
  • Development of a decision-relative, context-based framework for clinical application.
  • Analysis of composite cases to illustrate the proposed approach.

Main Results:

  • Significant jurisdictional variation exists in the extent of effort required to locate surrogate decision-makers.
  • State laws differ on the level of certainty clinicians need regarding the identity of apparent surrogate decision-makers.
  • The study highlights a gap in consistent legal and ethical guidelines for identifying unbefriended patients.

Conclusions:

  • A standardized, decision-relative, context-based approach is needed to guide clinicians in identifying unbefriended patients.
  • Clearer guidelines can improve the process of surrogate decision-making for vulnerable patient populations.
  • Addressing the 'unbefriended' status is essential for ethical and legal patient care.