Informed Consent and Surrogate Interference at the Initiation of Community-Based Palliative Care Services

Area of Science:

• Bioethics
• Palliative Care
• Clinical Ethics

Background:

• Community-based palliative care (CBPC) clinicians face ethical dilemmas when surrogates revoke patient consent.
• Surrogate motivations can range from protection to self-interest.

Purpose of the Study:

• To ethically analyze whether an adult can revoke another adult's informed consent for palliative care.
• To examine the patient's capacity, surrogate's intent, and clinician's duties.

Main Methods:

• Ethical analysis of informed consent in palliative care.
• Review of surrogate decision-making principles (substituted judgment and best interest).
• Consideration of the clinician's duty of care.

Main Results:

• Valid informed consent for palliative care should be honored.
• Surrogate revocation of consent presents an ethical challenge.
• Clinicians have a responsibility to proceed with care based on patient consent.

Conclusions:

• CBPC clinicians should provide palliative care services to patients who have given valid informed consent.
• Patient autonomy in initiating palliative care must be respected, even against surrogate objections.