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Posted on December 18, 2017 at 5:00 AM

I have had the pleasure of serving with Jay Baruch on the board of ASBH, the nation’s largest bioethics association. Jay is an emergency medicine physician and professor in Rhode Island. He has a great new article in Stat on how “when death is imminent, end-of-life care decisions sometimes go out the window.”

When I speak on any topic relating to healthcare decisions (POLST, unrepresented patients, advance directives..), the most frequent question I get concerns what to do when the surrogate contravenes the patient’s instructions or known wishes.

I have argued (and here among other places) that clinicians not only have no duty to follow “bad” surrogates, they have an affirmative duty to NOT follow directions that contravene the patient’s prior instructions or known wishes. Unfortunately, this rule is too rarely followed in practice.

Admittedly, patient wishes are often vague, such that there is no contradiction. In those cases, in the grey zone, surrogates are typically given discretion to interpret patient instructions and wishes.  

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