Medicine Grand Rounds: Treatment over Objection: Ethics at the Intersection of Patients' Rights and Professional Values

This talk begins by cataloging the many ways that decision-making capacity (DMC) assessment routinely goes wrong and, in turn, the way decisionally incapacitated patients are inappropriately excluded from their own care. These failures converge on a hard case: the patient who lacks DMC by conventional measures but holds firm preferences about what happens to them. Against the received view that surrogate-authorized, reasonably beneficial treatment should proceed over such a patient's objection, the talk argues that clinical medicine has leaned too heavily on DMC alone, and that other capacities, such as the capacity to have preferences, the capacity to refuse, and the capacity to designate a surrogate, are distinct from DMC and independently morally relevant. The conclusion is that decisionally incapacitated patients often still possess influential or even authoritative voices over what is done to them.