Surrogate Consent: Why Do We Need It?

To The Editor: In the March 2007 issue of the Journal, Cynthia M.A. Geppert, M.D., Ph.D. and Christopher Abbott, M.D. presented a not so uncommonly encountered situation in multidisciplinary/multispecialty settings where psychiatrists provide consultation liaison services. This usually means the assessment of an individual for his or her capacity to provide informed consent for a medical and/or surgical procedure, as in the case presented by Drs. Geppert and Abbott. They aptly highlighted the need for the assessment of individuals with psychiatric illness for the ability to consent to other medical procedures and decisions. The presence of a psychiatric illness does not preclude the consenting ability of an individual, since there may be areas that are unaffected by the psychopathology where these individuals have the capacity to exercise their free will based on their information and judgment. However, the recommendation by Drs. Geppert and Abbott to the medical team that “the inpatient psychiatric service was encouraged to devote more effort and resources to contacting Mr. B’s mother to arrange for a surrogate decision maker” ( 1, p. 410) did not seem to keep well in their overall assessment of the patient. While it was advisable for the treatment team to make efforts to contact the family members and/or care givers of the individual to ensure more comprehensive management, they should not have been asked to give surrogate consent in this case. Since the psychiatrists found the patient competent enough to reasonably understand the nature of his medical condition, its likely course, and the available treatment modalities with their potential pros and cons, he should have been allowed to make decisions on his own in this regard. This would have helped in holding the voluntarism of the individual and hence his right “for the treatment” or, in this case, the right “not for the treatment” as planned by the team.