Surrogate Decision Making in the Aftermath of Intra-Family Violence

Abstract: Intrafamilial violence affects an estimated 10 million people annually in the U.S. Healthcare professionals are frequently called upon to provide care to survivors of violence and at times patients alleged to be perpetrator of violence. The standards of care and for decision-making among critically ill patients apply whether or not they are incarcerated. If incapacitated, surrogate decision making is intended to protect a person’s rights and interests while they are unable to make decisions for themselves. Healthcare professionals have an obligation to identify ethically appropriate surrogates with knowledge of a patient’s values and preferences. How should this duty be honored for an individual accused of an act of violence? Family who would otherwise be called upon to represent the interests of those patients following an act of intrafamilial violence may experience significant emotional distress serving in this role. There exists a duality in their role as familial advocate and as a survivor of violence at the hands of the patient. Some of the extrinsic barriers affecting family members are their concerns for bias and mistreatment at the hands of law enforcement and healthcare professionals who they fear may dehumanize their loved one due to alleged crimes. Based on a clinical ethics consult request, author will discuss their role as an ethics consultant addressing the varying and at times conflicting ethical perspectives of healthcare professionals, law enforcement, and family of an incapacitated patient alleged to have committed devastating acts of violence against members of their own family and themself.