Thursday, September 22, 2011
Who should be the Surrogate?
A middle aged patient is intubated for respiratory distress. The patient has been estranged from the majority of her family for many years. The patient's brother has been acting as surrogate decision-maker. The daughter shows up at the bedside claiming she should be the surrogate since she is next-of-kin. What criteria should be used to determine a surrogate decision-maker?
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The criteria which should be used to determine a surrogate decision-maker for the patient in this scenario consist of a few criteria; first would be to check for the patient’s advance directives. If the patient had none, it would be seen as fit to continue to have her brother act as a surrogate. This could be supported by the following facts; the brother has most likely known the patient much longer and has possibly discussed what she would want for her health. This supersedes of the fact that medical issues are a topic which are less likely to be discussed between a parent and their child. The child’s age would also be a factor in this situation, if the daughter is younger, than it is less likely that she would know what the best decision would be to make for her mother. There is also the consideration that the patient has been estranged from her family for many years yet her brother was the first one there to be the surrogate. Finally it comes down to whether or not the patient’s brother is competent and capable of making logical decisions based off the patient’s wants, needs and medical advice. If the brother thinks in the best interest of the patient without any anterior motives then he should continue to be the surrogate decision-maker in this situation.
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