O'Brien Meghan, Fiester Autumn
University of California-San Francisco, 1545 Divisadero Street, 1st Floor, San Francisco, CA 94115 USA. Meghan.O'
Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, 3401 Market Street, Suite 320, Philadelphia, PA 19104-3319 USA.
J Clin Ethics. 2014 Winter;25(4):273-80.
Existing state surrogate decision-maker laws are fragmented and inconsistent and fail to ensure that all eligible decision makers of the same surrogate priority class are included in the healthcare decisions made for an incapacitated loved one. In this article, we explore three categories of harm that result from failing to include all surrogates of equal priority in a patient's healthcare decision, namely harms to the patient, harms to the excluded surrogate, and harms to the family. Given these harms, we argue that clinical ethicists have a moral obligation to take reasonable steps to include all surrogate decision makers of equal priority in the healthcare decision-making process for patients without a designated healthcare proxy.
现有的州替代决策者法律零散且不一致，无法确保同一替代优先级类别的所有合格决策者都参与为无行为能力的亲人做出的医疗决策。在本文中，我们探讨了因未将所有同等优先级的替代者纳入患者医疗决策而导致的三类危害，即对患者的危害、对被排除的替代者的危害以及对家庭的危害。鉴于这些危害，我们认为临床伦理学家有道德义务采取合理措施，将所有同等优先级的替代决策者纳入没有指定医疗代理人的患者的医疗决策过程中。
