Book contents
- Frontmatter
- Contents
- Foreword
- Note on drugs and abbreviations
- Section I Palliative Management
- Section II Major discomforts in advanced neurological illness
- Section III Major neurological conditions requiring palliation
- Section IV Ethical issues
- 1 Consent and decision-making
- 2 Advance directives
- 3 Proxy decision-making
- 4 Ethical issues in states of disordered consciousness
- 5 Terminal sedation
- 6 Euthanasia
- Section V Appendices
- Index
3 - Proxy decision-making
from Section IV - Ethical issues
Published online by Cambridge University Press: 08 January 2010
- Frontmatter
- Contents
- Foreword
- Note on drugs and abbreviations
- Section I Palliative Management
- Section II Major discomforts in advanced neurological illness
- Section III Major neurological conditions requiring palliation
- Section IV Ethical issues
- 1 Consent and decision-making
- 2 Advance directives
- 3 Proxy decision-making
- 4 Ethical issues in states of disordered consciousness
- 5 Terminal sedation
- 6 Euthanasia
- Section V Appendices
- Index
Summary
Cognition is compromised in many neurological conditions; often it is impossible to anticipate the onset of cognitive impairment. The timing and the extent of that impairment may be elusive, and the patient may worry that decisions regarding care will be made by individuals who have no awareness of his personality or priorities.
The patient may wish to designate a particular individual who is to be trusted to make decisions or give consent on the patient's behalf for medical or surgical treatments. Who is to take that responsibility? In some countries an individual patient can, while competent, formally appoint, by a duly witnessed, legally binding document, another person to be a medical advocate, a guardian and a surrogate decision-maker.
Where legislation to authorize the appointment of a proxy decision-maker is not in place, it may be possible to ensure that, during the earlier stages of an illness when cognition remains close to normal, matters of future directions are raised in ways that allow family members to feel confident about the patient's fears and hopes, and to know what are the patient's directions and wishes, in future times of potential difficulty. In such a case, a clear and agreed understanding among family members about ‘what Mother said she wanted’ can be very helpful, and guide compassionate medical care in the terminal stage. It may be taken into account if a legal judgment becomes necessary.
- Type
- Chapter
- Information
- Palliative Neurology , pp. 207 - 208Publisher: Cambridge University PressPrint publication year: 2005