Consent, Advance Directives, and Decision by Proxies

The ethical principle of autonomy, the right of a patient to determine what therapies or interventions to accept or decline, has wide support in modern medical ethics and is strongly buttressed legally. Accordingly, clinicians need to have a robust familiarity with the statutes governing their practice, notably in such realms as advance directives and proxy decision-making. Ethical challenges frequently arise in the context of emergency and critical care medicine in which time-sensitive or highly consequential decisions must be made when the patient’s decision-making capacity is impaired or subject to question. This chapter addresses these challenges and offers potential approaches and solutions.