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In advance directives, we tell our physicians and surrogate decision makers what types of care we want--and don't want--when we can no longer make decisions for ourselves. But research consistently shows a gap between patients' preferences for end-of-life care and what their surrogate decision makers think those patients want. Neuroscience and, more specifically, a specific form brain imaging -- fMRI -- may be able to help close that gap. By imaging a person's brain while he or she is making a decision, researchers can tell which part of the brain is being brought to the specific decision-making task. Such findings have shown that the part of the brain that becomes active when a research subject is making decisions based on purely personal preference is different from the part that becomes active when the subject is making socially or morally guided decisions. Instructing a surrogate to make one's end-of-life decisions should be a social, morally guided decision, not a purely personal one. So perhaps posing end-of-life care questions in a social, moral frame rather than a purely personal frame will elicit care decisions from patients that align more closely with decisions their surrogates would make.
By AMA Journal of Ethics4.8
2020 ratings
In advance directives, we tell our physicians and surrogate decision makers what types of care we want--and don't want--when we can no longer make decisions for ourselves. But research consistently shows a gap between patients' preferences for end-of-life care and what their surrogate decision makers think those patients want. Neuroscience and, more specifically, a specific form brain imaging -- fMRI -- may be able to help close that gap. By imaging a person's brain while he or she is making a decision, researchers can tell which part of the brain is being brought to the specific decision-making task. Such findings have shown that the part of the brain that becomes active when a research subject is making decisions based on purely personal preference is different from the part that becomes active when the subject is making socially or morally guided decisions. Instructing a surrogate to make one's end-of-life decisions should be a social, morally guided decision, not a purely personal one. So perhaps posing end-of-life care questions in a social, moral frame rather than a purely personal frame will elicit care decisions from patients that align more closely with decisions their surrogates would make.

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