Actions Can Speak Louder Than [Written] Words: Surrogate Decision Making Based on Stated Preferences

摘要

Baek (2016) eloquently recounts the case of an unfortunate gentleman who sustained a severe neurologic insult and had a poor likelihood of meaningful neurological recovery. This report is illustrative of heart-wrenching cases encountered daily across the health care spectrum—where the surrogate’s beliefs, patient’s wishes, and lack of advance care preference documentation make clinical decisions challenging. While we support Baek’s overall conclusions and believe this case highlights many important points, we believe some issues require further clarification and exploration prior to drawing conclusions. In particular, we begin with the notion that the decision to focus on comfort care was supported despite the fact that “the patient did not have a progressive condition.” Prioritization of a comfort- directed strategy comports with the law and medical practice, whereby patients (or their surrogates) maintain not the right to die, but “the right to be left alone” and have unwanted interventions discontinued when not consistent with their goals, values or preferences. As such, the lack of a progressive condition becomes secondary in this case and many other cases like it.