Thanks for clarifying your concerns about potential conflict of interest. Honestly, the only issue you identified which (in my opinion) constitutes a true conflict of interest would be that of a dual role. However, I'm having difficulty envisioning when or how you would serve as both advocate and surrogate at the same time. Given that surrogacy only becomes active when a client is deemed to no longer have capacity, I'm not sure there would be an opportunity for you to provide both services simultaneously. Both services could be part of the client contract, but they would be consecutive services, not concurrent.
The circumstance of a family member paying for your services but disagreeing with the client's wishes is a concern, but one I would address up front when entering into the contracted services. Regardless of who pays the bill, the patient is my client. If the family is not okay with that, I am not the right advocate for them — and that's 100% okay.
The remaining concerns you cited seem to be potential ethical conflicts for us as advocates/surrogates. As a social worker, I have supported many (MANY) clients through situations and choices that were not aligned with my own beliefs. I wish I could offer some words of wisdom other than to say that you have to know where your red lines are. I know mine — and they are bright red!
I served as guardian for many adults who set ground rules about contact with or notification of their loved ones. Because I was court-ordered to make decisions in their best interest, I documented these requests very clearly and also told them when I would and would not be able to honor them. In a case of an advocacy client, that client (or the family member paying for advocacy services) could then have the option to choose a different advocate if they were uncomfortable with my position.
The simplest answer is that your first obligation is to yourself personally. Requests that make you question whether you would be able to sleep at night (look yourself in the mirror, require an additional trip to the confessional, etc.) are ones that merit deep consideration with a mentor, an attorney, and/or your clergy of choice.
These are great questions, Alison, and I look forward to input from others. In my previous role as a public guardian (appointed by the probate court in my state), I had very clear guidelines on decision-making, and while the healthcare proxy/surrogate role is slightly different, I feel the decision-making process is much the same. Where I do have some questions is on the question of how I would respond if there were a family member contesting my decisions. In my guardian role, I always educated and encouraged family members to take their concerns to the probate court, where the judge would issue a ruling on the legal appropriateness of my decision-making.
Can you give any examples of concerns about conflict of interest?
In a surrogacy situation, the court likely still has some ability to hear concerns and issue findings. Which court? That probably varies from state to state. Developing or obtaining a document that potential surrogacy clients complete AND review with both you and any involved (or potentially involved) family members is key. Reviewing that document after any significant health changes and with some regularity is essential.
I plan to consult with my attorney on this before moving forward with accepting any surrogacy cases in which there is the possibility of family dispute. Heck — even the most basic families disagree over these kinds of issues. I might only accept surrogacy clients who are truly solo agers!
The circumstance of a family member paying for your services but disagreeing with the client's wishes is a concern, but one I would address up front when entering into the contracted services. Regardless of who pays the bill, the patient is my client. If the family is not okay with that, I am not the right advocate for them — and that's 100% okay.
The remaining concerns you cited seem to be potential ethical conflicts for us as advocates/surrogates. As a social worker, I have supported many (MANY) clients through situations and choices that were not aligned with my own beliefs. I wish I could offer some words of wisdom other than to say that you have to know where your red lines are. I know mine — and they are bright red!
I served as guardian for many adults who set ground rules about contact with or notification of their loved ones. Because I was court-ordered to make decisions in their best interest, I documented these requests very clearly and also told them when I would and would not be able to honor them. In a case of an advocacy client, that client (or the family member paying for advocacy services) could then have the option to choose a different advocate if they were uncomfortable with my position.
The simplest answer is that your first obligation is to yourself personally. Requests that make you question whether you would be able to sleep at night (look yourself in the mirror, require an additional trip to the confessional, etc.) are ones that merit deep consideration with a mentor, an attorney, and/or your clergy of choice.
Can you give any examples of concerns about conflict of interest?
In a surrogacy situation, the court likely still has some ability to hear concerns and issue findings. Which court? That probably varies from state to state. Developing or obtaining a document that potential surrogacy clients complete AND review with both you and any involved (or potentially involved) family members is key. Reviewing that document after any significant health changes and with some regularity is essential.
I plan to consult with my attorney on this before moving forward with accepting any surrogacy cases in which there is the possibility of family dispute. Heck — even the most basic families disagree over these kinds of issues. I might only accept surrogacy clients who are truly solo agers!
Thanks for opening this conversation!