Informed Consent and Surrogate Interference at the Initiation of Community-Based Palliative Care Services

TL;DR

This paper explores the ethical dilemma of when a surrogate revokes a patient's valid consent for palliative care and argues that clinicians should still provide care.

Contribution

The paper provides a novel ethical analysis of surrogate interference in community-based palliative care.

Findings

Clinicians have an ethical duty to provide care even if a surrogate revokes the patient's consent.

Surrogates may act out of self-interest or protective instincts when interfering with care.

The analysis considers patient capacity, surrogate intent, and clinician duty.

Abstract

Community-based palliative care (CBPC) clinicians sometimes contend with an ethically charged scenario when they encounter patients for the first time: The patient’s spouse, or other loved one or caregiver, revokes the patient’s valid informed consent to initiate care. While surrogates are usually motivated by protective instincts, there are other situations where surrogates act out of self-interest. This article considers whether it is ever ethically justified for an adult to revoke another adult’s valid informed consent to initiate palliative care services. The article examines this scenario from three perspectives: the patient’s capacity to give or relinquish informed consent, the surrogate’s intent and use of substituted judgment or best interest, and the clinician’s duty to provide clinical care. This ethical analysis argues that CBPC clinicians have an ethical responsibility to provide palliative care services for patients who have given valid informed consent for those services even when a surrogate acts as an interfering or oppositional force.