Deciding for Others: The Ethics of Surrogate Decision Making(Studies in Philosophy and Health Policy)

This book is the most comprehensive treatment available of one of the most urgent--and yet in some respects most neglected--problems in bioethics: decisionmaking for incompetents. Part I develops a general theory for making treatment and care decisions for patients who are not competent to decide for themselves. It provides an in-depth analysis of competence, articulates and defends a coherent set of principles to specify suitable surrogate decisionmakers and to guide their choices, examines the value of advance directives, and investigates the role that considerations of cost ought to play in decisions concerning incompetents. Part II applies this theoretical framework to the distinctive problems of three important classes of individuals, many of whom are incompetent: minors, the elderly, and psychiatric patients. The authors' approach combines a probing analysis of fundamental issues in ethical theory with a sensitive awareness of the concrete realities of health care institutions and the highly personal and individual character of difficult practical problems. Its broad scope will appeal to health professionals, moral philosophers and lawyers alike.

Table of Contents:
Preface; Introduction; Part I. Theory: 1. Competence and incompetence; 2. The primary ethical framework: patient-centered principles; 3. Advance directives, personhood, and personal identity; 4. Distributive justice and the incompetent; Part II. Application: 5. Minors; 6. The elderly; 7. The mentally ill; Looking forward; Appendix 1: living trust and nomination of conservatorship; Appendix 2: durable power of attorney for health care; Notes; Index.

Review :
"Few problems in medicine so puzzle and pain families, healthcare workers, and officials as much as those about making decisions for incompetent people. Allen Buchanan and Dan Brock have made a signal, and major, contribution to the analysis of such issues. They have, first of all, contributed an elegant and thoughtful theory, and then they have moved, second, from the theoretical to the practical realm, trying to spell out how in practice the incompetent might best be respected and treated. This book will have a central and enduring place in future discussion, pertinent not only to those interested in the theoretical questions, but to those charged with actually caring for, and deciding for, the incompetent. It will help illuminate a problem that seems both intractable and painful. That is a giant contribution." Daniel Buchanan, Director of the Hastings Center "Buchanan and Brock's treatment of surrogate decision making is an outstanding example of the type of scholarship which the field [of bioethics] needs. The combination of its intellectual virtues with its comprehensiveness of treatment will make this book the standard work on this important topic for years to come." Baruch A. Brody, Baylor College of Medicine "Buchanan and Brock's special contribution is to bring systematic moral reasoning and consideration of social and institutional practices to bear on a spectrum of questions related to incompetence. The result is a subtle, selective, and philosophically sophisticated work." Hastings Center Report "Deciding for Others addresses an important issue with wide-ranging implications for health care and will undoubtedly become a work of major significance." Dermot K. Feenan, Journal of Health, Politics, Policy and Law "This excellent and challenging book discusses virtually the whole range of ethical questions that arise when medical decisions must be made by someone other than the patient...Buchanan and Brock's invigorating treatment will remain a key point of departure for anyone who wants to better understand the ethics of treatment refusal." Medical Humanities Review "From such a pair one would expect a landmark, and one is not disappointed." Jonathan D. Moreno, Ethics "Deciding for Others has much to teach the general reader who may have read press coverage of major court descisions such as Cruzan. It also makes an enormous contribution to current scholarly debates regarding surrogate decision making in medicine, law, and ethics. Brock and Buchanan move present debates forward by leaps and bounds." Uriel Barzal