Will a Patient Preference Predictor Improve Treatment Decision Making for Incapacitated Patients?

One of the cornerstones of contemporary medicine is the patient’s right to decide about his or her medical treatment. Clinicians respect this right by obtaining the informed consent of competent patients, but face a dilemma in the many cases in which patients lack decisional capacity—for example, due to sudden events like stroke or head trauma or as a result of a gradual decline in cognitive function. A series of high-profile court cases in the United States, most notably the cases of Karen Quinlan in 1976 and Nancy Cruzan in 1990, spurred the development of the current ethical and legal framework for making treatment decisions for incapacitated patients. The framework primarily aims to extend the patient’s right to decide about his or her medical treatment into times of decisional incapacity. It encourages patients to discuss and document prospectively how they want to be treated in the event of incapacity. If patients lose the ability to make their own decisions, they will then be treated according to their previously stated preferences and values. When no clear advance direc-tive is available, clinicians ask a surrogate decision maker—usually a member of the patient’s family or a loved one—to make medical decisions based on the surrogate’s best estimate for how the patient would want to be treated in the given situation (the “substituted judgment ” standard). When it is unclear how the patient would want to be treated, clinicians and surrogates choose the course of treatment that best promotes the patient’s clinical interests. This framework for respecting the rights of incapacitated patients is widely endorsed, and it has been adopted not only in the United States, but i