The Milbank quarterly
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Usual medical care often fails to meet the needs of chronically ill patients, even in managed, integrated delivery systems. The medical literature suggests strategies to improve outcomes in these patients. ⋯ The challenge is to organize these components into an integrated system of chronic illness care. Whether this can be done most efficiently and effectively in primary care practice rather than requiring specialized systems of care remains unanswered.
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The Milbank quarterly · Jan 1996
What is the moral authority of family members to act as surrogates for incompetent patients?
Policy and practice regarding the proper role of family members in acting as surrogate decision makers for incompetent patients often suffer from an incomplete understanding of the diverse grounds of families' moral authority to act as surrogates. The different, sometimes conflicting, grounds of family surrogacy are explored: (1) its establishment by democratic decision processes; (2) the self-determination of the incompetent patient; (3) the fact that a family member usually acts according to the patient's wishes and interest; (4) the reality that family members are usually most affected by the patient's decisions; (5) consideration of these effects; (6) a recognition that the family is a moral unit, responsible for its members. Each of these grounds must be considered when selecting a surrogate or deciding on the proper scope of the surrogate's decision-making authority.