ABSTRACT
This chapter evaluates the requirements of informed consent for health care providers and researchers. It presents an alternative ways to obtain the informed consent of children and incompetent adults. The chapter focuses on the options available when patients or their surrogates and health care providers cannot agree about medical decisions. It assesses parental choice as a decisionmaking standard for children with profound mental and physical impairments. Advance directives of either type can be the basis of a substituted judgment, or decision about medical treatment made by a previously competent patient's surrogate according to an interpretation of what the patient would have wanted. American and British courts have different views about the weight of the best-interest standard for incompetent adults when an advance directive is not available. In America, it is the last resort in the absence of substituted judgment. Storar illustrates the difficulties involving ethical decisionmaking for never competent patients.
