Explain the concept and moral foundations of surrogate decision-making.
Describe the ethical and legal criteria for choosing a surrogate and for surrogate
Identify classic ethical dilemmas of surrogate decision-making, for example:
family stake in treatment decisions, reliability of surrogate decision-makers,
potential conlicts between possible surrogates, and between surrogates and care
Mr. D was a 57-year-old man with a history of schizoaffective disorder and drug abuse who
presented to the emergency department with a diffuse painful maculopapular rash, blistering
of his mouth, sloughing of skin at the tip of his nose and a temperature of 104 degrees.
He required urgent intubation due to extensive oropharyngeal involvement and an increasing
oxygen requirement in the emergency department. He was admitted to the burn intensive care
unit and diagnosed with drug-induced toxic epidermal necrolysis caused by a new psychiatric
medication that was begun severalweeks prior to his presentation. His rash involved 95 percent
of his body including his mucous membranes and his eyes.
His hospital course was complicated bywound infection, sepsis requiring pressors, hypotension,
acute renal failure, and severe pain, particularly with dressing changes. He had a prolonged
stay in the intensive care unit and remained ventilator dependent. His prognosis based
on his presentation, including the extent of skin involvement and subsequent complications,
was poor. His mortality was estimated at greater than 75 percent and, even if he survived a several
month intensive care unit stay, he would require a lengthy, painful rehabilitation course
and likely lifelong assistance with care either at a facility or with care providers in his home.