Responding to surrogate requests that seem inconsistent with a patient's living will

Elizabeth K. Vig, Rebecca L. Sudore, Karina M. Berg, Erik K. Fromme, Robert M. Arnold

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


Clinicians may feel conflicted when a patient's legal decision maker is making decisions that seem inconsistent with a patient's living will. We provide evidence-based information to help clinicians consider whether a surrogate's inconsistent decisions are ethically appropriate. Surrogates are not flawless translators of their loved one's preferences; they are influenced by their own hopes and the current clinical context. Patients may be aware of this, are often concerned about burdening their loved ones, and often grant their surrogates leeway in interpreting their wishes. When appropriate, clinicians should respect surrogates' interpretations of patient values and take steps to decrease surrogate stress during the decision-making process. Finally, if clinicians are cognizant of their own values and preferences, they may recognize how these may affect their responses to certain clinical cases.

Original languageEnglish (US)
Pages (from-to)777-782
Number of pages6
JournalJournal of Pain and Symptom Management
Issue number5
StatePublished - Nov 2011
Externally publishedYes


  • Surrogates
  • advance directives
  • decision making
  • substituted judgment

ASJC Scopus subject areas

  • Nursing(all)
  • Clinical Neurology
  • Anesthesiology and Pain Medicine


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