Dr Anson Fehross1
1Sydney Health Ethics, University Of Sydney
Group substitute decision maker (SDM) appointments refer to cases where a patient, anticipating future incompetency, appoints multiple SDMs to decide on their behalf. Despite the availability of group SDM appointments throughout Australia and elsewhere, little effort has been expended to demonstrate their potential benefits.
This reticence can be traced to the concern that group deliberations will result in deadlock, failing to offer a unanimous decision in a timely manner, or failing to decide at all. In the case of intractable deadlock, this decision would likely be taken out of the hands of SDMs altogether and into the hands of courts or tribunals. In both instances, an individual SDM could have avoided these outcomes. It is for this reason that critics consider it imprudent, at best, to rely upon a group.
I suggest that the possibility of deadlock is an outcome that should be embraced rather than avoided. To arrive at this conclusion, I will briefly motivate the case for group SDMs by demonstrating that a properly organised group is likely to produce higher quality, and more representative, decisions than any individual SDM could reasonably expect to achieve. I then argue that while deadlock can often be avoided via careful attention to the appointment of group members, deadlock in some instances can reveal something important about the patient and what they value, providing key insights that can inform further steps. As I hope to show, sometimes deadlock serves as evidence of ambivalence—ambivalence that the patient themselves would likely share.
Biography:
Anson Fehross recently completed his PhD at Sydney Health Ethics, University of Sydney. His thesis sets out a new model for substituted decision making, which incorporates insights from cognitive psychology, philosophy of medicine, and psychiatry.