TY - JOUR

T1 - Doctors as Appointed Fiduciaries

T2 - A Supplemental Model for Medical Decision-Making

AU - Davies, Ben

AU - Parker, Joshua

PY - 2022/1/30

Y1 - 2022/1/30

N2 - How should we respond to patients who do not wish to take on the responsibility and burdens of making decisions about their own care? In this paper, we argue that existing models of decision-making in modern healthcare are ill-equipped to cope with such patients and should be supplemented by an "appointed fiduciary" model where decision-making authority is formally transferred to a medical professional. Healthcare decisions are often complex and for patients can come at time of vulnerability. While this does not undermine their capacity, it can be excessively burdensome. Most existing models of decision-making mandate that patients with capacity must retain ultimate responsibility for decisions. An appointed fiduciary model provides a formalized mechanism through which those few patients who wish to defer responsibility can hand over decision-making authority. By providing a formal structure for deferring to an appointed fiduciary, the confusions and risks of the informal transfers that can occur in practice are avoided. Finally, we note how appropriate governance and law can provide safeguards against risks to the welfare of patients and medical professionals.

AB - How should we respond to patients who do not wish to take on the responsibility and burdens of making decisions about their own care? In this paper, we argue that existing models of decision-making in modern healthcare are ill-equipped to cope with such patients and should be supplemented by an "appointed fiduciary" model where decision-making authority is formally transferred to a medical professional. Healthcare decisions are often complex and for patients can come at time of vulnerability. While this does not undermine their capacity, it can be excessively burdensome. Most existing models of decision-making mandate that patients with capacity must retain ultimate responsibility for decisions. An appointed fiduciary model provides a formalized mechanism through which those few patients who wish to defer responsibility can hand over decision-making authority. By providing a formal structure for deferring to an appointed fiduciary, the confusions and risks of the informal transfers that can occur in practice are avoided. Finally, we note how appropriate governance and law can provide safeguards against risks to the welfare of patients and medical professionals.

KW - Clinical Decision-Making

KW - Decision Making

KW - Humans

KW - Physician-Patient Relations

KW - Physicians

KW - autonomy

KW - medical decision-making

KW - shared decision-making

KW - doctor–patient relationship

U2 - 10.1017/S096318012100044X

DO - 10.1017/S096318012100044X

M3 - Journal article

C2 - 35049458

VL - 31

SP - 23

EP - 33

JO - Cambridge Quarterly of Healthcare Ethics

JF - Cambridge Quarterly of Healthcare Ethics

SN - 0963-1801

IS - 1

ER -