Bearing Witness at the Bedside: The Role-Specific Obligations of Surrogate Decision-Makers

In "Can I Get a Witness? The Ethical Dimensions of Family Presence in Patient Suffering," Jennifer Blumenthal-Barby and colleagues ask whether there is a duty for family members to be present at the bedside of an unconscious or minimally conscious patient. In responding to the article, I argue that the authors' presumption against a general duty for this bedside presence follows in part from the level of generality at which the question is posed. As the categories "family," "unconscious," and "suffering" are too heterogeneous to generate a single, action-guiding obligation of bedside presence, I suggest that the question should be reframed as one concerning whether surrogate decision-makers should be thought of as incurring narrower role-specific obligations that sometimes require bedside presence. In surfacing the practical circumstances in which questions surrounding perceived family absence are typically raised by clinicians, this reply also suggests an overlooked dimension of such conflicts: they may signal uncertainty about the conditions under which surrogate authority is being exercised. The possibility that this uncertainty underlies clinicians' occasional frustration can become an important conceptual foothold for clinical ethics facilitation.