Abstract

Like some ethical dilemmas, this question has an obvious answer that may not be right. On first reflection, it seems entirely unreasonable and inappropriate to expect staff members to withhold supportive care. Legally, a designated surrogate has the authority to refuse pain medication on the patient's behalf, but is it ethically defensible? A patient lacking decisionmaking capacity is crying out in pain; can we really imagine just closing the door? What do we say to other patients, visitors, and staff members, such as physicians, nurses, housekeepers, and dietary workers, who might hear the patient? Do we place a sign on the door, one noting that the surrogate has refused, on behalf of the patient, to authorize the administration of pain medication and that the hospital or nursing home must comply with the surrogate's decision?