Surrogate decision-making
This ethical standard asks a surrogate to make the decision the patient would have made if able.
What is substituted judgment?
The clinical determination that a patient can understand, appreciate consequences, reason through options, and communicate a choice.
What is decision-making capacity?
A court-ordered arrangement that would allow parents to make decisions for an adult patient who lacks capacity.
What is legal guardianship?
In Baby John’s case, this ethical standard is used because infants cannot express their own wishes.
What is the best interest standard?
If the surrogate does not know the patient’s wishes, this standard asks what option most promotes the patient’s welfare.
What is the best interest standard?
Written or oral statements of a patient’s preferences for medical treatment if they become unable to decide.
What are advance directives?
The legal threshold marking the transition from childhood to adulthood where patients are generally presumed to have the ability to make their own medical decisions.
What is the age of majority?
Pursuant to Colorado law, John’s mom was identified through a statutory surrogate-identification process and formally appointed as John’s medical decision maker.
Who is the interested party?
This ethical principle gives parents primary authority to make medical decisions for their child unless those decisions clearly harm the child.
What is parental authority?
Because infants cannot express preferences, medical decisions are typically made by these people.
Who are parents or legal guardians?
This ethical decision-making standard for patients who lack capacity, generally replaces “best interest” when a patient transitions from childhood to adulthood
What is substituted judgment
After assessment, the team determined that John was unable to demonstrate this ability with respect to refusing dialysis at that time.
What is decision-making capacity?
Commonly cited in bioethics, this legal doctrine allows the state to override parental or surrogate decisions if a child or adult without capacity is at risk of serious harm.
What is parens patriae?
This document designates someone to make medical decisions on behalf of the patient.
What is a medical durable power of attorney?
This arises when clinicians impose their own views about quality of life on patients often undermining patient autonomy.
What is paternalism?
The tension between ethics principles in both adult and infant John’s cases arises when aggressive treatment may prolong life but also increase suffering.
What is the balance between beneficence and nonmaleficence?
This term describes when, in the state of Colorado, a doctor may be assigned to make medical decisions on behalf of a patient who lacks decision making capacity when no surrogates or interested parties could be located.
What is physician proxy?
This component requires recognizing how medical information applies personally to one’s own situation.
What is appreciation?
This element of capacity involves grasping the facts about a diagnosis and proposed treatment.
What is understanding?
This element of capacity involves John clearly expressing a consistent choice.
What is communication?