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

Community-based palliative care (CBPC) clinicians sometimes contend with an ethically charged scenario when they encounter patients for the first time: The patient’s spouse, or other loved one or caregiver, revokes the patient’s valid informed consent to initiate care. While surrogates are usually m...

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Main Author: John C. Stys
Format: Article
Language:English
Published: Mary Ann Liebert 2024-10-01
Series:Palliative Medicine Reports
Subjects:
Online Access:https://www.liebertpub.com/doi/10.1089/pmr.2024.0018
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author John C. Stys
author_facet John C. Stys
author_sort John C. Stys
collection DOAJ
description Community-based palliative care (CBPC) clinicians sometimes contend with an ethically charged scenario when they encounter patients for the first time: The patient’s spouse, or other loved one or caregiver, revokes the patient’s valid informed consent to initiate care. While surrogates are usually motivated by protective instincts, there are other situations where surrogates act out of self-interest. This article considers whether it is ever ethically justified for an adult to revoke another adult’s valid informed consent to initiate palliative care services. The article examines this scenario from three perspectives: the patient’s capacity to give or relinquish informed consent, the surrogate’s intent and use of substituted judgment or best interest, and the clinician’s duty to provide clinical care. This ethical analysis argues that CBPC clinicians have an ethical responsibility to provide palliative care services for patients who have given valid informed consent for those services even when a surrogate acts as an interfering or oppositional force.
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spelling doaj-art-3625d0fa1c094aeb8a4b43fcdeaf00f52025-08-20T02:59:07ZengMary Ann LiebertPalliative Medicine Reports2689-28202024-10-015123423710.1089/pmr.2024.0018Informed Consent and Surrogate Interference at the Initiation of Community-Based Palliative Care ServicesJohn C. Stys0Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Chicago, Illinois, USA.Community-based palliative care (CBPC) clinicians sometimes contend with an ethically charged scenario when they encounter patients for the first time: The patient’s spouse, or other loved one or caregiver, revokes the patient’s valid informed consent to initiate care. While surrogates are usually motivated by protective instincts, there are other situations where surrogates act out of self-interest. This article considers whether it is ever ethically justified for an adult to revoke another adult’s valid informed consent to initiate palliative care services. The article examines this scenario from three perspectives: the patient’s capacity to give or relinquish informed consent, the surrogate’s intent and use of substituted judgment or best interest, and the clinician’s duty to provide clinical care. This ethical analysis argues that CBPC clinicians have an ethical responsibility to provide palliative care services for patients who have given valid informed consent for those services even when a surrogate acts as an interfering or oppositional force.https://www.liebertpub.com/doi/10.1089/pmr.2024.0018autonomybest interestcapacityconsentduty of caresubstituted judgment
spellingShingle John C. Stys
Informed Consent and Surrogate Interference at the Initiation of Community-Based Palliative Care Services
Palliative Medicine Reports
autonomy
best interest
capacity
consent
duty of care
substituted judgment
title Informed Consent and Surrogate Interference at the Initiation of Community-Based Palliative Care Services
title_full Informed Consent and Surrogate Interference at the Initiation of Community-Based Palliative Care Services
title_fullStr Informed Consent and Surrogate Interference at the Initiation of Community-Based Palliative Care Services
title_full_unstemmed Informed Consent and Surrogate Interference at the Initiation of Community-Based Palliative Care Services
title_short Informed Consent and Surrogate Interference at the Initiation of Community-Based Palliative Care Services
title_sort informed consent and surrogate interference at the initiation of community based palliative care services
topic autonomy
best interest
capacity
consent
duty of care
substituted judgment
url https://www.liebertpub.com/doi/10.1089/pmr.2024.0018
work_keys_str_mv AT johncstys informedconsentandsurrogateinterferenceattheinitiationofcommunitybasedpalliativecareservices