Question

You read an NEJM article on surrogate decision maker statutes for this module, which illustrates the inconsistency in terminology and eligibility to serve as a surrogate decision maker. However, the reality of incompetent patients and surrogate decision makers is not always very clear. Consider the following:

A patient presents with  gangrene and requires a leg amputation. The patient refuses the amputation, and persisted in the refusal. She also has a history of cognitive deterioration, and it is possible that her refusal stems from this rather than a rational consideration of the risks of the treatment and foregoing the treatment. The patient's daughter argues that her mother is not competent to decide her own care, and demands that the physician perform the surgery, but no court has yet deemed the mother incompetent and appointed the daughter guardian. What do you think the physician should do: follow the patients wishes and not perform the surgery, or the daughter's demands that the surgery proceed?

Answer 1

The physician has no right to perfRom any type of procedure when the patient refuses the treatment. When a Pati ent is not mentally sound cannot make decisions, at this time a surrogate decision maker takes the decision when legally permitted. Here the patient has no legal surrogate decision maker,so the physician has to fill a form and send to the jurisdictions of the patients residing localities. Here usually two to three physicians are involved .Moreover it is not an emergency where a physician or surgeons take decisions.