When the patient can't decide

Family members are often called upon to make medical choices for patients who are unable to do so themselves. Researchers led by Alexia Torke, M.D., of the Indiana University School of Medicine and the Regenstrief Institute, Inc., studied how physicians treating these patients interacted with surrogate decision-makers.

The qualitative study, based on interviews with physicians who described their own recent interactions with surrogate decision makers, is published in the Summer 2008 issue of the Journal of Clinical Ethics. Their findings led the researchers to conclude that physicians' ethical framework for making decisions in which a surrogate is involved is much more complex than previously realized. Although ethicists have traditionally encouraged physicians to focus exclusively on the patient, physicians in the study also considered the surrogate's wishes and interests in their decision making.

"The number of times that a physician will deal with a surrogate decision maker is growing as our population ages and conditions such as Alzheimer's disease become more common. The issue of how physicians interact with surrogates is a very important one. We found that physicians often want to take an active role in determining what is right for a patient and often grapple with the needs of the patient versus those of the surrogate," said Dr. Torke, who is an IU School of Medicine assistant professor of medicine and geriatrics and a Regenstrief research scientist. She is also on the faculty of the IU Center for Aging Research and the Fairbanks Center for Clinical Medical Ethics

Some physicians encouraged families to consider the patient's prior wishes and to place them ahead of other considerations. One said, "I always think it's important that it's not a decision that the family member or the surrogate is making for themselves but it is a decision that they are making for someone else, based upon their best knowledge of what that person would want."

Another doctor participating in the study told the researchers, "When I feel strongly that the patient's quality of life is really poor then I do feel that it is appropriate for the physician to try and guide the family member toward a decision."

Another felt that sometimes guidance is not enough and said, "If the patient can't make the decision then I discuss it with the family. I sometimes will push the family to do what I think is best for the patient."

Other physicians were willing to base decisions on what the surrogate wanted for the patient, rather than enquiring about what the patient would have wanted. Physicians were also concerned with the surrogate's well-being, including their emotions, but found the surrogate's needs to be less important than patient-centered concerns. One doctor said, "I think family burden is an issue. I don't think it should govern what the final decision is, but I do think it should be addressed."

Source: Indiana University

Related stories:

Study shows false memories complicate end-of-life treatment decisions
Advance directives, or living wills, may not effectively honor end-of-life wishes because life-sustaining treatment preferences often change over time without people being aware of the changes, according to a new study co-authored by UC Irvine researchers Peter Ditto and Elizabeth Loftus.
Spouse might not become medical surrogate
U.S. researchers say one-third of married individuals choose someone other than their spouse as a surrogate for medical decision-making.
How Washington hospitals unleashed a MRSA epidemic
Year after year, the number of victims climbed. But even as casualties mounted - as the germ grew stronger and spread inside hospitals - the toll remained hidden from the public, and hospitals ignored simple steps to control the threat.
Doctors' questions about end-of-life legalities may result in patient pain
When treatment options dwindle or are exhausted, terminally ill-patients often opt for pain management and comfort over life-extending therapies. However, a team of researchers from Wake Forest University Baptist Medical Center, University of Rochester Medical Center and Unity Health System, report that a lack of thorough understanding about the laws governing end-of-life care may be leaving many medical providers with an ethical dilemma and causing some terminally-ill patients considerable, unnecessary pain.
Crossing the digital divide
What will motivate the elderly, the chronically ill and the medically underserved to use interactive information technology systems to actively help manage their own health problems? What barriers have prevented people in these groups from using such systems more widely than they have?
New performance measures refine tools for improving care of heart attack patients
A new set of clinical performance measures will help doctors and hospitals give the best possible care to heart attack patients by providing up-to-date tools for gauging how closely they're sticking to guideline recommendations and where they need to improve.
Burrowing into bias
If you saw any of the political debates between Biden and Palin or McCain and Obama, you know who won. It was obvious. Isn't it odd, though, that so many people in the media and elsewhere saw the same debate and thought the other side won? How could they see the world so differently? Are they stupid or just biased?
Multiple sclerosis progression can be predicted with MRI
A new study published in Journal of Neuroimaging shows that MRI scans used on multiple sclerosis (MS) patients to determine if the disease has affected gray matter in the brain can identify those at-risk for progression of disability.

News discussion:

Medicine & Health news