Dear Colleague,

How often have patients or family members asked you "What would you do if this was your mother (father, child, spouse, etc.)?" How often have you asked yourself "If this was my loved one, would I do things differently?" Ethical situations arise daily and when it comes to decision-making, there are so many variables that can come into play – living wills, do-not-resuscitate orders, disagreements among families or surrogate decision makers, prior experience, your own moral and ethical beliefs, and so on.

An article in the current issue of the Journal of Hospice and Palliative Care Nursing sheds some light on a particularly interesting consideration regarding decision making. In Why Surrogates Don't Make Decisions the Way We Think They Ought to: Insights From Moral Psychology, we learn about a hierarchy of three ethical standards which should help surrogates to make decisions consistent with a patient's wishes, however research shows that this often is not the case. The three standards in the hierarchy are:

1. known wishes,
2. substituted judgment,
3. and best interests.

In this article, the authors present 5 assumptions that are implicit when using this hierarchy, including a discussion of how can one predict preferences for an unknown circumstance in the future? I encourage you to read this article in its entirety to learn more!

Ethics is a big topic in healthcare – you can also read more by exploring the articles in More Resources and our Focus On: Nursing Ethics resource collection.

Why Surrogates Don't Make Decisions the Way We Think They Ought to: Insights From Moral Psychology Ethical Issues: Putting the Meds in the Applesauce Christian Ethics: Ethics and Empathy (Part One) Christian Ethics: Ethics and Empathy (Part Two) Use of Digital Health Records Raises Ethics Concerns Is It Ethical to Do Dialysis But Not Cardiopulmonary Resuscitation?

Lisa Bonsall, MSN, RN, CRNP
Clinical Editor

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