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Proxy consent and counterfactual wishes.

E Wierenga

    The Journal of Medicine and Philosophy
    |November 1, 1983
    PubMed
    Summary

    Proxy consent for incompetent patients requires respecting prior wishes when expressed. For those with no prior opinion, prioritizing the patient's best interests is crucial, not counterfactual desires.

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    Area of Science:

    • Medical Ethics
    • Philosophy of Medicine
    • Legal Medicine

    Background:

    • Determining valid consent for medical treatment for incompetent individuals is ethically complex.
    • Existing frameworks for proxy consent often struggle with cases lacking prior patient directives.

    Purpose of the Study:

    • To delineate conditions for valid proxy consent for medical treatment of incompetent persons.
    • To propose an ethically sound principle for decision-making when prior patient wishes are unknown.

    Main Methods:

    • Distinction between previously competent patients with expressed wishes and those without.
    • Critical analysis of the 'counterfactual wishes' principle for proxy consent.
    • Development of an alternative principle based on patient best interests.

    Main Results:

    • Proxy consent is valid when it respects the previously stated wishes of a competent individual who is now incompetent.
    • The principle of respecting counterfactual wishes is deemed ethically inadequate.
    • A principle centered on the patient's best interests is proposed as a superior alternative.

    Conclusions:

    • Respecting prior directives is paramount for proxy consent validity in previously competent patients.
    • Decision-making for never-competent or previously-competent-without-directives patients should prioritize best interests over hypothetical preferences.
    Keywords:
    Analytical ApproachPhilosophical ApproachProfessional Patient Relationship

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