Saturday, 24 March 2012

Emedinews:Insights on Medicolegal issues: Who is a surrogate medical decision maker for patient?

Studies suggest that spouses and other family members generally do not know the preferences of patients regarding the termination of life–sustaining treatments; therefore, they may not reach the same decision that the patient would have reached.1 One study found that even though patients believed both their family (87 %) and doctors (90 %) could accurately represent their wishes, neither family members nor doctors were able to adequately predict patient wishes on scenario testing with agreement ranging from 59 to 88 %.2 This discrepancy emphasizes the importance of patient/surrogate discussions about preference prior to a loss of capacity. Unfortunately, these proactive discussions are rare and clinicians are usually left relying on the family for decisions.
1. Emanuel EJ, Emanuel LL. Proxy decision making for incompetent patients: An ethical and empirical analysis. JAMA 1992;267:2067.
2. Shalowitz D, Garrett–Mayer E, Wendler D. The accuracy of surrogate decision–makers. Arch Intern Med 2006;166:493.

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