Article Figures & Data
Figures
- Figure 1.
Reconceptualizing the experience of surrogate decision making.
Tables
Surrogate Position Example Surrogate report Mr H had amyotrophic lateral sclerosis diagnosed 7 years ago. Over the years he has declared multiple times that he does not want to be kept alive on a ventilator. He had considerable decline in the last year and continued to refuse ventilator support. When he goes into respiratory distress, he is asked again about his wishes and confirms. When he becomes severely hypoxic and delirious despite oxygen by mask, the physician turns to his wife as his surrogate. His wife honors her husband’s wishes saying: “He told me many times that he never wants to be on a ventilator, and I am carrying out his wishes.” Surrogate decision Mrs F has severe chronic obstructive pulmonary disease and has recently been given a diagnosis of stage-4 lung cancer that has metastasized to the liver. She has no advance directives, and her husband never had conversations with her regarding medical care. When she is admitted with obstructive pneumonia, she is intubated and requires ventilatory support. After 10 days she has not improved. She has suffered a non- Q wave myocardial infarction and a small cerebrovascular infarct, and she has developed acute renal failure during the hospital course. Her husband is asked to decide whether to do a tracheostomy or to treat her with comfort measures and stop ventilatory support. He asks that everything be done while he comes to terms with his wife’s death.
The Article in Brief
Reconceptualizing the Experience of Surrogate Decision Making: Reports vs Genuine Decisions
Laurence B. McCullough , and colleagues
Background When patients are no longer able to make decisions about their life-sustaining treatment, family members or legal representatives must serve as surrogate decision makers. Their decisions are based on substituted judgment (the patient's values and preferences) or, if such values aren't known, they are based on what is in the patient's best interest. In this article, the authors reexamine this decision-making model to better reflect the experience of making surrogate decisions.
What This Study Found The authors propose that the current model of surrogate decision making be replaced by a new model. The new model distinguishes between making decisions for the patient, which is necessary when patient preferences are not known, and making reports on the patient's behalf when preferences are known. Making reports carries less stress and anguish than actual surrogate decision making.
Implications
- The concept of surrogate decision making should be used only when actual decision making is needed. Clinicians should help patients distinguish between making reports and making decisions.
