Doctors as Appointed Fiduciaries: A Supplemental Model for Medical Decision-Making

Abstract

How should we respond to patients who do not wish to take on the responsibility and burdens of making decisions about their own care? In this paper, we argue that existing models of decision-making in modern healthcare are ill-equipped to cope with such patients and should be supplemented by an “appointed fiduciary” model where decision-making authority is formally transferred to a medical professional. Healthcare decisions are often complex and for patients can come at time of vulnerability. While this does not undermine their capacity, it can be excessively burdensome. Most existing models of decision-making mandate that patients with capacity must retain ultimate responsibility for decisions. An appointed fiduciary model provides a formalized mechanism through which those few patients who wish to defer responsibility can hand over decision-making authority. By providing a formal structure for deferring to an appointed fiduciary, the confusions and risks of the informal transfers that can occur in practice are avoided. Finally, we note how appropriate governance and law can provide safeguards against risks to the welfare of patients and medical professionals.

Exploring the Influence of Decisionmaking Style and Financial Status of Cancer Patients on Varied Cultural Aspects of Decision Process

“…Surprisingly, there were no significant differences between the two decision-making styles in the attribution of responsibility for treatment decisions, except in case of chance/luck. Though paternalistic decisionmaking is associated with increased responsibility on the part of doctors compared to patients or family caregivers (Davies & Parker, 2022), in this study no such distinctions were found. Further, previous literature suggests the tendency of patients and family caregivers to relegate to metaphysical beliefs, for instance, beliefs in god, karma or chance/luck to explain the occurrence of illness (Kohli & Dalal, 2016).…”

“…Regardless of contextual factors, the findings indicate that patient’s agency was consistently low for conditions of paternalistic decision-making, wherein doctors solely bear decision responsibilities (Davies & Parker, 2022). In a study, Blok et al (2023) interviewed 40 family caregivers of patients undergoing life-assistive treatment.…”