PHI 2396 Chapter Notes -Best Interests, Expressive Aphasia, Parens Patriae
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Physicians feel that they have fulfilled their duty when they educate and advice a person in a
language that they understand on what to do and tell them an opinion and a recommendation.
What happens after is legally and ethically acceptable. If they don’t agree with decision they can
attempt to reason or persuade but not coerce. If they can’t do the required task, they can refer
the patient to another physician and withdraw the case. At no point, minus emergencies and
therapeutic privileges, are they called to assume the role of proxy-decision maker or to examine
the ethical acceptability of the decision
This is different in the case of an incompetent person
Physician must assume an evaluative role; make sure the proxy-decision maker (usually the
next of kin) make the right decision after reflective consideration and not a hasty reaction
Must analyse the criteria used by proxy-decision maker to ensure their decision does not reflect
their standards, feelings or expectations bur rather are ethically appropriate
When in doubt, engage legal and administrative channels to prevent unacceptable exercise of
The physician will base his result on past experiences with the patient and their
recommendations along with the quality of life expected from the medical treatments.
If no past-encounter, he will base it on the quality of life standards currently accepted by the
Will analyze the person to make sure he is not just a living biological life but rather a person who
has cognitive awareness and the possibility for meaningful social interaction
Decision based on: prior knowledge and experience, standard perception on quality of life,
humanity, likelihood of outcomes and decisions taken by people in similar situations in the past.
Radically Congenitally Incompetent Patient
The case of a person who has never been “normal” and possibly would never be competent is
It is unfair to make decisions for them because their quality of life is way different from ours and
our judgements and subjective knowledge will cloud our judgement. Physician would use the
world experience of someone who fits the norm of a reasonable person.
It would violate the individuality of the patient.
Re Stephan Dawson Case
Criteria to consider when making decisions as a proxy-decision maker:
1. Congenitally incompetent person does not lose the rights to health care normally
enjoyed by other persons simply in virtue of his or her incompetence
2. The duty of exercising this right normally rests in the parents as appropriate proxy
3. Their decision-making authority is appropriately challenged when it is not exercised in
the best interests of the incompetent person
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