Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-25T05:12:23.770Z Has data issue: false hasContentIssue false

Extubating Mrs. K: Psychological Aspects of Surrogate Decision Making

Published online by Cambridge University Press:  01 January 2021

Extract

Mrs. K is a thirty-one-year-old Russian-speaking mother of two, who was brought in by ambulance after attempting suicide by jumping in front of train. Probable depression x months. Stressor: lost custody battle over older child. Current status: deep coma, ventilator-dependent, and prognosis grim. Next of kin is estranged husband; he demands participation in medical decision making. Legal proxy is patient's boyfriend; forcibly removed from the intensive care unit (ICU) for agitated behavior and alcohol intoxication.

I magine the difficulty for the ICU staff as it tries to patch together the broken body of Mrs. K, described above. If, as appears likely, the physicians’ efforts begin to fail, who will speak for this patient, who can no longer speak for herself, and determine the appropriate goals and limits of intensive medical care?

Type
Article
Copyright
Copyright © American Society of Law, Medicine and Ethics 1999

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

See Nelson, H.L. and Nelson, J.L., The Patient in the Family: An Ethics of Medicine and Families (New York: Routledge Press, 1995).Google Scholar
See, for example, New York State Task Force on Life and Law, When Others Must Choose: Deciding for Patients Without Capacity (New York: New York State Task Force on Life and the Law, 1992).Google Scholar
In re Quinlan, 335 A.2d 647 (N.J. 1976).Google Scholar
See Jacobson, J.A. et al., “Patients' Understanding and Use of Advance Directives,” Western Journal of Medicine, 16 (1994): 232–36; Hare, J. and Nelson, C., “Will Outpatients Complete Living Wills? A Comparison of Two Interventions,” Journal of General Internal Medicine, 6 (1991): 41–46; and Bok, S., “Personal Directives for Care at the End of Life,” N. Engl. J. Med., 295 (1976): 367–69.Google Scholar
For arguments against living wills, see Lynn, J., “Why I Don't Have a Living Will,” Law, Medicine & Health Care, 19 (1991): 101–04.CrossRefGoogle Scholar
See Brett, A.S., “Limitations of Listing Specific Medical Interventions in Advance Directives,” JAMA, 266 (1991): 825–28.CrossRefGoogle Scholar
See, for example, Zweibel, N. and Cassel, C., “Treatment Choices at the End of Life: A Comparison of Decisions by Older Patients and Their Physician Selected Proxies,” Gerontologist, 29 (1989): 615–21.Google Scholar
See, for example, Uhlmann, R.F. Pearlman, R.A., and Cain, K.C., “Physicians' and Spouses' Predictions of Elderly Patients' Resuscitation Preferences,” Journal of Gerontology, 43, no. 5 (1988): M115M121.Google Scholar
See Tolstoy, L., Anna Karenina (New York: Viking Penguin, 1954).Google Scholar
See Katz, J., The Silent World of Doctor and Patient (New York: Free Press, 1984).Google Scholar
See Minuchin, S., Families and Family Therapy (Cambridge: Harvard University Press, 1974).Google Scholar
See, for example, Blustein, J., “Organ Donation and the Question of Paternity” (unpublished manuscript).Google Scholar
See Bishop, E., “In the Village,” in Bishop, E., The Collected Prose (New York: Farrar, Straus, Giroux, 1984): 251–74.Google Scholar
Id. at 251.Google Scholar
See Dubler, N.N., “The Doctor-Proxy Relationship: The Neglected Connection,” Kennedy Institute of Ethics Journal, 5 (1995): 289306.CrossRefGoogle Scholar
See Gilligan, C., In a Different Voice (Cambridge: Harvard University Press, 1982).Google Scholar
See Gilligan, C. et al., eds., Mapping the Moral Domain (Cambridge: Harvard University Press, 1988).Google Scholar
See Murphy, S.T. et al., “Ethnicity and Advance Care Directives,” Journal of Law, Medicine & Ethics, 24 (1996): 108–17. See also Blackhall, L.J. et al., “Ethnicity and Attitudes Toward Patient Anatomy,” JAMA, 274 (1995): 820–25.Google Scholar
See, for example, Emanuel, L.L. et al., “Advance Directives for Medical Care—A Case for Greater Use,” N. Engl. J. Med., 324 (1991): 889–95; and Danis, M. et al., “A Prospective Study of Advance Directives for Life-Sustaining Care,” N. Engl. J. Med., 324 (1991): 882–88.Google Scholar
See In re John Storar, 420 N.E.2d 64 (N.Y. 1981); and Cruzan v. Director, Missouri Department of Health, 497 U.S. 261 (1990).Google Scholar
See, for example, Ariz. Rev. Stat. Ann. § 36–3231 (West 1998); Colo. Rev. Stat. Ann. § 15–18.5–103 (West 1999); and S.C. Code Ann. § 44-66-30 (Law Co-op. 1998).Google Scholar