A great deal of consensus exists on the moral principle of autonomy. However, when closely examined in practice, autonomy can be extremely difficult to protect, especially when patients are incompetent or severely compromised in their decision-making capacities. Therefore, we rely on advance directives from the patient, or from a duly informed surrogate (preferably delegated to act as a durable power of attorney or appointed healthcare decision maker), when the patient becomes unable to make decisions.

In practice, however, despite policies and even laws legislating advance directives about resuscitation and end-of-life care, patients can suddenly become incapacitated before obtaining adequate information about their choices in terms of advance directives or patient-appointed surrogate decision makers. There are legal precedents for establishing an order of surrogate decision makers. Closest family members are usually considered the first choice as surrogates because it is...

You do not currently have access to this content.