Commentary on Fiester’s “TIEC, Trauma Capacity, and the Moral Priority of Surrogate Decision Makers in Futility Disputes,” Others’ Responses on This Topic, and, Then, Her Responses to Them

In this issue Autumn Fiester and several other experts explore optimal ethical approaches to surrogate decision-making and trauma-informed ethics consultation (TIEC). Trauma-informed care is currently recommended in many clinical contexts in which the risks of patients being traumatized by their illness and its treatment are present. This care gives priority to patients feeling safe, an asymptotic goal that prescribes no one standard practice for all patients, but one that prescribes individualized treatment tailored to each patient’s idiosyncratic needs. Core points Fiester makes are how patients are especially prone to feeling traumatized when others, as is always the case with their providers, have greater power over them and the rarely considered conclusion that although providers have exceptional medical expertise and experience, this does not necessarily provide them with greater ethical expertise than their patients or others. Fiester’s most radical contention may be that providers, including ethics consultants, give priority to patients’ and surrogate decision makers’ feelings. I discuss here these contentions and Fiester’s main aim of first creating and then maintaining trust and caring feelings between all parties, no matter how much initially they may disagree. I discuss, too, how legally her suggestions may be implemented immediately.