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Medical Ethics |

Navigating Ethical Conflicts Between Advance Directives and Surrogate Decision-Makers’ Interpretations of Patient Wishes

Courtenay R. Bruce, JD, MA; Trevor Bibler, PhD; Andrew M. Childress, PhD; Ashley L. Stephens, MA; Adam M. Pena, MA; Nathan G. Allen, MD
Author and Funding Information

CORRESPONDENCE TO: Courtenay Rose Bruce, JD, MA, Center for Medical Ethics and Health Policy, Baylor College of Medicine, One Baylor Plaza, MS: BCM420, Houston, TX 77030


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(2):562-567. doi:10.1378/chest.15-2209
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There is little guidance on what clinicians should do when advance directives (or living wills, specifically) are challenged, particularly when surrogate decision-makers’ interpretations of patients’ wishes conflict with the living will. In our commentary, we make a controversial argument suggesting that overriding living wills can be ethically preferable to the alternative of strictly adhering to them. We propose four ethical considerations for determining whether it is ethically supportable to override living wills.


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