"When Surrogates Say 'No', How Should Physicians Respond?"

In this presentation, Dr. Moskop will offer a moral analysis of situations in which surrogate decision-makers and physicians disagree about treatment for patients who lack decision-making capacity.  The presentation will begin with several examples of cases in which surrogates refuse physician-recommended treatment for patients without capacity.  After a review of the moral rationale for relying on surrogate decision-makers, Dr. Moskop will consider who should be authorized to serve as surrogates for patients who lack capacity and describe three standards commonly used to guide and assess surrogates’ decisions.  He will identify and evaluate multiple physician options for responding to surrogates’ refusals of treatment.  The presentation will conclude with brief comments on the introductory cases.

Dr. John Moskop is Professor of Internal Medicine and Wallace and Mona Wu Chair of Biomedical Ethics at the Wake Forest School of Medicine.  He chairs the Clinical Ethics Committee at Wake Forest Baptist Medical Center and is a core faculty member in the Wake Forest Masters Degree Program in Bioethics.  From 1979 through 2009, he was a faculty member in the Department of Medical Humanities of The Brody School of Medicine at East Carolina University.  He served as a visiting professor at the Center for Bioethics of the Medical College of Wisconsin in 1994.   Dr. Moskop is author of more than one hundred articles and book chapters on ethical issues in emergency medicine, death and dying, organ transplantation, the allocation of health care, and other topics in bioethics.  His new book, Ethics and Health Care: An Introduction, published by Cambridge University Press, was released in March of this year. Dr. Moskop serves on the Ethics Committee of the American College of Emergency Physicians and is a consultant to the Ethical and Judicial Affairs Committee of the North Carolina Medical Society.  He is Treasurer and a member of the Board of Directors of the Academy for Professionalism in Health Care.