Health care professionals and clinical ethicists find it challenging to determine what, exactly, a surrogate decision-maker is doing when making his decision. Is he using the patient's stated wishes to inform his judgment of what the patient would have wanted or attempting to determine what is in the patient's best interests? Or is he weighing his own best interests, influenced by some combination of caregiving burden, possible financial gain, grief, anger, and/or guilt? While it can be difficult to separate FB's decision-making for his father from the burden that he bears as a caregiver, it is impossible to imagine a scenario in which a family member would not have these investments coloring a decision (or at least guilt at the lack of them). But when a surrogate articulates reasoning that reflects what is important to the patient, as FB did, then his decisions can be judged consistent with good surrogacy, even if he could "gain" something from a particular decision.
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