What would Terri want? On the psychological challenges of surrogate decision making.

The Terri Schiavo case was unique in the media attention it garnered, but the decision making challenges faced by Terri's family are common ones encountered by all families who must make choices about the use of life-sustaining medical treatment for an incapacitated loved one. This article highlights three key issues that were particularly problematic in the Schiavo case, but that represent general psychological challenges inherent to the task of surrogate decision making. The 3 central points of uncertainty, and therefore conflict, in the Schiavo case concerned: (a) the appropriate standard by which medical decisions for Terri should be made, (b) the specific nature of Terri's wishes about the use of life-sustaining medical technology, and (c) the true extent of disability and prognosis for recovery represented by Terri's medical condition. No simple remedy is possible that will resolve all of the uncertainties inherent to surrogate decision making, but some general strategies for improving the quality of end-of-life medical decisions are discussed.