Hastings Center Report
Centering Care as Normal and Valuable
Abstract: This commentary, which responds to the article “Models of Relational Medical Decision-Making: Caregivers and Advanced Life-Sustaining Treatment,” by Aaron Wightman and Georgina Campelia, in the same issue of this journal, argues for reorienting medical decision‑making around care rather than patient autonomy alone. Drawing on empirical studies and disability bioethics, it asserts that most patients prefer involving physicians and caregivers in decision-making. Empirical studies show that many patients prefer physician‑directed or collaborative decisions and commonly weigh the input of caregivers. Additionally, patients frequently factor the potential burden on family into difficult treatment choices, undermining strict substituted decision‑making. Normatively, focusing on care acknowledges human dependency and the moral significance of caregiving, which resists ableist tendencies that render carers invisible. The author endorses Wightman and Campelia’s care‑centered model, showing that it better reflects actual decision-making practices and validates dependence and caregivers’ labor.
