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Sometimes people lose the ability to make their own healthcare decisions. When this happens, these important decisions need to be made by someone who is acting on the patient’s behalf. These decision makers are either someone the patient has named in an advance directive (healthcare agent) or determined by the legal hierarchy in Georgia. These people are referred to as surrogate decision makers.
For medical or surgical treatment decisions:
For Do Not Resuscitate (DNR):
Regardless of who the surrogate decision maker (SDM) is or how they were appointed, there are certain expectations of him or her when making healthcare decisions.
First, if there is an advance directive which includes treatment preferences, then the SDM is expected to follow those preferences. It is also important that the SDM not make decisions based on their own preferences, but those of the patient.
As discussed earlier, there is an expectation that the SDM honor the patient’s wishes and be guided by those wishes when making decisions. The healthcare team is looking for the SDM to express what the patient’s wishes would be if they could speak for themselves. There are two ways to think about what to do when trying to make decisions:
This means making the same decision that the patient would make if they could make the decision themselves. These decisions are made based on the patient’s values, goals and past behaviors.
Questions to help quide substituted decision-making:
This is used when the patient’s values, goals and past behaviors are unknown. This means making decisions that look at both the positive and negative sides of possible treatment(s). The SDM should think about what they want to happen and the likelihood of that happening with the available treatment options.
Questions to help guide Best-Interest decision making:
When using the best-interest standard, best interest should be determined from the perspective of the patient, not that of the SDM.