WHAT IS THE MORAL AUTHORITY OF FAMILY MEMBERS TO ACT AS SURROGATES FOR INCOMPETENT PATIENTS

Policy and practice regarding the proper role of family members in act ing as surrogate decision makers fur incompetent patients often suffer from an incomplete understanding of the diverse grounds of families' moral authority to act as surrogates. The different, sometimes conflic ting, grounds of family surrogacy are explored: (1) its establishment by democratic decision processes; (2) the self-determination of the in competent patient; (3) the fact that a family member usually acts acco rding to the patient's wishes and interest; (4) the reality that famil y members ate usually most affected by the patient's decisions; (5) co nsideration of these effects; (6) a recognition that the family is a m oral unit, responsible for its members. Each of these grounds must be considered when selecting a surrogate or deciding on the proper stupe of the surrogate's decisionmaking authority.