SCCMA BioEthics Committee Share a Model Policy on Health Care Decisions for Incapacitated Patients Without Surrogates (Update to SCCMA 2001 Policy)
The SCCMA Bioethics Committee updated a policy written in 2001. The new document, Health Care Decisions for Incapacitated Patients Without Surrogates: Revisions to the 2001 SCCMA Model Policy, is intended as guidance to provide procedural mechanisms whereby ethically and medically appropriate health care decisions can be made on behalf of adult persons who lack health care decision-making capacity and for whom no willing and able surrogate decision-maker can be identified.
The original policy was written in 2001. Because the previous policy was over 20 years old, it was felt by the Bioethics Committee that a revised and updated policy was necessary. A three person subcommittee of the SCCMA Bioethics Committee was formed to establish a newer revised policy. There was subsequent input from the Bioethics Committee as a whole with recent final adoption by a vote of the Committee.
Our revised policy has the following Purpose Statement: To provide procedural mechanisms whereby ethically and medically appropriate health care decisions can be made on behalf of adult persons who lack health care decision-making capacity and for whom no willing and able surrogate decision-maker can be identified.
This policy represents a consensus among members of the Ethics Committee of the Santa Clara County Medical Association with legal input, about the most appropriate manner by which to make medical decisions on behalf of hospitalized incapacitated patients who lack surrogate decision-makers. Despite their incapacity, such patients are entitled to have ethically and medically appropriate decisions made on their behalf and to have these decisions made in their best interest, respecting their wishes and values as much as they can be known. Decisions about treatment should be made on sound medical advice and be made without the influence of material conflicts of interests of the provider, institution or affected parties. The procedures set forth here are intended to meet these goals. This policy is considered necessary since no clear-cut legal guidelines exist that cover these circumstances in hospitalized patients. This policy is designed to provide uniformity and consistency, within a hospital, on the process to make medical treatment decisions for incapacitated patients who lack a surrogate decision maker. Finally, this policy and its procedural protections were considered necessary to support the institutions informed consent policy and avoid of non-beneficial, medically ineffective, or excessively burdensome interventions.
Goals to be achieved:
1. To make and effect health care decisions in accordance with a patient's best interest, taking into consideration the patient's personal values and wishes to the extent that these are known.
2. To establish uniform procedures to implement appropriate health care decisions for incapacitated patients without a surrogate decision maker. Appropriate healthcare decisions include both the provision of needed and wanted medical treatment and the avoidance of non-beneficial or excessively burdensome treatment. Appropriate health care decisions are also those that are based on sound medical advice and made without the influence of material conflicts of interest.
PDF: Bioethics Committee’s Health Care Decisions for Incapacitated Patients Without Surrogates: Revisions to the 2001 SCCMA Model Policy