Table 1.

Surrogate Report and Surrogate Decision

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.

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.