Models of Relational Medical Decision-Making: Caregivers and Advanced Life-Sustaining Treatment

Area of Science:

• Biomedical Engineering
• Healthcare Ethics
• Patient Care Technology

Background:

• Increasing reliance on advanced life-sustaining technologies (ALSTs) necessitates robust out-of-hospital caregiver support.
• Caregiver involvement is critical for patient well-being and ALST success, yet their labor and burdens are often overlooked.
• Existing decision-making models for ALSTs predominantly focus on patients, neglecting the vital role of caregivers.

Purpose of the Study:

• To address the gap in recognizing and valuing caregiver contributions in medical decision-making for ALSTs.
• To propose and evaluate models for shared decision-making that include both patients and their caregivers.
• To advocate for a more equitable approach to care labor within the context of advanced medical technologies.

Main Methods:

• Development of a taxonomy outlining various models for incorporating care labor into ALST decision-making.
• Analysis of existing literature and ethical frameworks related to caregiving and shared decision-making.
• Recommendation of a specific model grounded in care ethics principles.

Main Results:

• Identification of multiple potential models for recognizing caregiver impact in ALST decisions.
• Highlighting the frequent neglect of caregiver benefits and burdens in current patient-focused decision-making.
• Proposal of a care-centered model as a superior framework for equitable shared decision-making.

Conclusions:

• The care-centered model, rooted in care ethics, offers a just and comprehensive approach to ALST decision-making.
• This model equitably values both the caregiving relationship and the individuals within it.
• Implementing shared decision-making inclusive of caregivers is essential for ethical and effective ALST implementation.