OBJECTIVE BEST INTERESTS STANDARD
The surrogate determines the incompetent patient's best interests by considering:
Relief of suffering
Quality and extent of sustained life (as viewed by patient).
NOTE: The individual's value to society is not a factor.
Figure 2-5. Under the objective best interests standard, the surrogate decides whether
refusal is in the best interests of the patient by considering the factors
shown. The patient's wishes and his or her value to society are not
Extent of impairment of patient's mental faculties.
Whether or not patient is in the custody of the state.
Prognosis with and without treatment.
Complexity, risk, and novelty of treatment.
Possible side effects.
Patient's level of understanding and probable reaction.
Urgency of the decision.
Consent of patient, spouse, or guardian.
Good faith of those participating in the decision.
Clarity of professional opinion as to what is good medical practice.
The interests of third persons.
Administrative requirements of the institution (different in each hospital).
Figure 2-6. A risk-benefit analysis may have more of a role to play for a never-
competent patient whose wishes are unknown. It may also be useful
as an aid to parents making decisions for minors.