According to a new study from the Regenstrief Institute at the Indiana University Center for Aging Research, decision-making by a surrogate for a family member who is unable to make medical decisions is more complicated than decision-making by patients themselves.
Family decision-makers consider not only the cognitively impaired patient’s wishes and interests but also their own. Some of the factors influencing their decision are respect for the patient’s input, the patient’s prior wishes, consideration of the patient’s interests, the surrogate’s own wishes as a guide, the surrogate’s religious and spiritual beliefs, the surrogate’s own interests, and the consensus of the family.
Many resort to using the 'Golden Rule'
“Family members often say that they wish they knew more about their loved one’s views on medical care,” said Regenstrief Institute investigator Alexia Torke, MD, associate professor of medicine at the IU School of medicine and an IU center for Aging Research scientist. “And whether or not surrogates know what the patient would have wanted had they been able to make the decision for themselves, we learned that family members may feel compelled to substitute what they themselves want, or to paraphrase the Golden Rule: do to others as you would have them do to you.”
Better guides for surrogates needed
Four out of 10 hospitalized adults no longer have the capacity for decision-making due to cognitive impairment. At that point, surrogates are often called. As the number of patients increase, the number of surrogates will as well.
“Because surrogates also imagine what they would want under the circumstances and consider their own needs and preferences as well as those of the patient for whom they’re acting, standard ethical models of surrogate decision-making [in the academic literature] must account for these additional considerations,” the paper stated. “Surrogates’ desire for more information about patient preferences suggests a need for greater advance care planning.”
Source: MedicalNewsToday, Indiana University