The volitional approach to surrogate decision making.

Area of Science:

• Medical Ethics
• Bioethics
• Healthcare Decision-Making

Background:

• Medical decisions for incapacitated patients rely on advance directives or surrogate decision-making.
• Patient wishes are often unclear, vague, or inconsistent, complicating surrogate decisions.
• Existing interpretative principles may fail to accurately capture patient autonomy.

Purpose of the Study:

• To propose interpretative principles for surrogate decision-making when patient wishes are unclear.
• To advocate for the volitional principle as the most effective method for respecting patient autonomy.
• To enhance the reliability of medical decisions for incapacitated patients.

Main Methods:

• Identification and analysis of three interpretative principles: value-substitution, value-coherence, and volitional.
• Argumentation for the superiority of the volitional principle in capturing patient intent.
• Examination of how the volitional principle supports patient sovereignty.

Main Results:

• The volitional principle is identified as the most reliable interpretative approach.
• This principle guides surrogates to align decisions with previously expressed patient wishes.
• It avoids imposing surrogate values or seeking coherence with unrelated patient values.

Conclusions:

• The volitional principle best supports patient sovereignty when decisional capacity is lost.
• Surrogates should prioritize the volitional principle to honor previously expressed patient wishes.
• This approach ensures medical decisions reflect the patient's likely choices, respecting their autonomy.