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

Studies in Philosophy and Health Policy

by Allen Buchanan, Dan W. Brock

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.

444 pages, Paperback

First published January 1, 1990

About the author

Allen Edward Buchanan is the James B. Duke Professor of philosophy at Duke University and also professor of the Philosophy of International Law at the Dickson Poon School of Law at King's College, London. He received his PhD from the University of North Carolina at Chapel Hill in 1975. He taught at the University of Arizona, the University of Wisconsin–Madison, and the University of Minnesota before joining Duke's faculty in 2002 as professor of public policy and philosophy. He has written six books covering such topics as Marx, applied ethics (especially bio-medical ethics), social justice, and international justice, including the foundations of international law. Buchanan served as staff philosopher for the President's Commission on Medical Ethics in 1983. From 1996 to 2000 he served on the Advisory Council for the National Human Genome Research Institute. He is a fellow of the Hastings Center, an independent bioethics research institution.

Reviews

[Pablo Frade · Rating 1 out of 5]

Traballo d etica. Realmente odio la filosofia analitica con todo mi ser. En fin la estrella es xq ahora puedo subirme las gafitas y decir alguna estupidez sobre directivas anticipadas e como poden ser unha forma d paternalismo en prol da autonomia y assdhdjfhfjfjrntjejrijf callaos ya dios

[Leslie · Rating 4 out of 5]

See outline. This is basic reading for those interested in (mostly) current ethical conceptualizations of surrogate decision-making. It has thorough explanations of guidance principles, along with ways they should practically be applied, how they compete with each other, and what their drawbacks are. At times the theory is thick and cumbersome, but it achieves overall conceptual clarity. The last 3 chapters deal specifically with issues common to minors, the elderly, and the mentally ill, respectively, and providers working frequently with these patient groups should likely be familiar with the material.

[Samuel Brown · Rating 4 out of 5]

Classic treatment of surrogate/proxy decision making and advance directives. While I'm not persuaded that the arguments they make about advance directives have proved to be well-validated empirically, this is an important, carefully argued book that was crucial in the history of medical decision making.