Interactive capacity, decisional capacity, and a dilemma for surrogates

AJOB Neuroscience 4 (4):36-37 (2013)
In “Conscientious of the Conscious: Interactive Capacity as a Threshold Marker for Consciousness” (2013), Fischer and Truog argue that recent studies showing that some patients diagnosed as being in a vegetative state are in fact in a minimally conscious state raise various ethical questions for clinicians and family members. I argue that these findings raise a further ethical dilemma about how and whether to seek the involvement of the minimally conscious person herself in decisions about her care. There may be a conflict between doing what is believed to accord with the patient’s prior stated wishes and/or her best interests, on the one hand, and respecting her own potential decision-making capacity and epistemic authority, on the other.
Keywords vegetative state  minimally conscious state  decision-making capacity  surrogate decision-making  best interests  substituted judgment  advance directive  consciousness  fMRI
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