A Legal and Ethical Analysis of the Effects of Triggering Conditions on Surrogate Decision Making in End of Life Care in the US
The central claim of this paper is that American states' use of so called "triggering conditions" to regulate surrogate decision making authority in end of life care leaves unresolved a number of important ethical and legal considerations regarding the scope of that authority. The paper frames the issue with a case set in a jurisdiction in which surrogate authority to withdraw life sustaining treatment is triggered by two specific clinical conditions. The case presents a quandary insofar as the clinical facts do not satisfy the triggering conditions, and yet both the appropriate surrogates and the care team agree that withdrawal of life sustaining treatment is in the best interest of the patient. The paper surveys applicable law across the 50 states and weighs the arguments for and against the inclusion of such triggering conditions in relevant legal regimes. The paper concludes by assessing the various legal and policy options states have for regulating surrogate decision making authority in light of the moral considerations (including epistemic difficulties) and notes the possibility for conflict within ethics teams arising from the potential tension between prudence, risk aversion, and moral obligation.
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