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A narrative approach to the ethical dilemmas of surrogate decision making

Abstract Surrogate decisions for incapacitated patients are challenging. Surrogates may be unreliable in their prediction of patient preferences. The responsibilities of the surrogate decision maker may result in psychological harm and moral distress. The substituted judgment standard of surrogate responsibility has been questioned on both philosophical and practical grounds. This article explores the ethical challenges of the surrogate decision maker and offers a defense of the surrogate's moral standing. The bioethical principle of respect for autonomy is contrasted with the concept of authenticity. A medical case is used to focus attention on the complexities of the surrogate's role. The case discussion seeks to demonstrate how attention to narrative information, the concept of authenticity, as well as the principles of bioethics, can help support the surrogate and establish a foundation for ethical consensus.