Representatives of the patient. Surrogate solution - Bioethics

Representatives of the patient. The surrogate solution

A representative of the patient is an extremely important concept in modern medical practice. The representative of the patient becomes the key figure in those situations when the patient, for one reason or another, can not or can not express his will on his own (juvenile age, incompetence, frustration of consciousness, general severe condition of the patient, etc.). In this case, the representative of the patient has the duty to competently represent the interests of his ward, make the best decisions in his favor, and also defend and defend his rights.

In developed countries, the appointment of a representative of the patient is practiced quite widely, which is associated with increased public attention to respect for the rights of the patient, as well as punctual regulation of various aspects of medical care.

Who can be a legal representative?

For minors and incompetent patients, the law provides for so-called mandatory representation. For minors, these are parents or persons substituting them, guardians for incompetent ones.

For a capable adult patient, the appointment of his representative occurs according to the will of the citizen himself. This is called voluntary representation. In domestic medical practice this case is usually denoted by the term "patient's trustee". A trusted person can be appointed not necessarily from among the closest relatives of the patient (although in practice this happens most often). The law authorizes the appointment of a trusted person to virtually any capable citizen. For example, for a single patient, a neighbor or a social worker can act as his confidant.

If the patient's clinical condition becomes severe (or is likely to become so), it is strongly recommended that the treating doctor himself as early as possible about the appointment of the patient's representative. To do this, the attending physician must find out who the patient trusts, and advise him to appoint his legal representative.

In addition, the patient has the opportunity to pre-order and about how he should be helped if in the future because of his condition, he himself can not make a decision.

In developed countries, a special practice is widely adopted, called "orders for the future", or "orders in advance" (advance directives). It consists in the fact that the patient in advance formulates and signs written instructions about how to treat him when a critical condition occurs (for example, he can refuse in advance to provide artificial support of vital functions), or (and) about who will be his representative and will receive the right to make decisions on behalf of the patient.

Practice of orders for the future is legal in some states. For example, in the United States in 1991, the Patient Self-Determination Act was adopted, according to which the medical institution is obliged to inform the patient about his right to express his orders for the future. In the UK, indications of the future are valid if they have been set out by the patient as clear instructions. In connection with the growing complexity of the processes of medical care, the practice of self-determination of a patient with regard to his future treatment will, as many experts believe, be the most important way to regulate decision-making problems in difficult situations. In our country, the practice of advance orders could be very useful, but while the current legislation clearly did not regulate it.

The decision made for an incompetent patient by his legal representative is called a surrogate solution. In this case, the right of informed consent is already placed on the legal representative, and medical workers must inform him according to all the requirements of ethics and law. At the same time, the legal representative has a moral duty to act in defense of the best interests of his ward.

If the legal representative decides not in the best interests of the patient (or even poses a direct threat of harm), in many countries (including the United States) in this situation there is a statutory right of the medical institution to challenge the actions of the patient's representative in judicial procedure.

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