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, according to a study from the Regenstrief Institute, Indiana University Center for Aging Research and the Charles Warren Fairbanks Center for Medical Ethics of Indiana University Health.
The researchers found that family decision-makers considered the cognitively impaired patient's wishes and interests. But they also took into account their own needs and preferences.
Factors influencing surrogate decision-makers included:
• Respect for the patient's input.
• The patient's prior wishes.
• Consideration of the patient's best interests.
• The surrogate's own wishes as a guide.
• The surrogate's religious and spiritual beliefs.
• The surrogate's own interests.
• Family consensus.
"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, M.D., 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.
"Surrogates also consider the feelings and beliefs of other family members," said Dr. Torke, senior author of the study. "The individuals who are making decisions for those who cannot are the survivors -- they take into account the fact that they have to live with other family members as and after they make surrogate decisions."
"Making Decisions for Hospitalized Older Adults: Ethical Factors Considered by Family Surrogates" is published in the Summer 2013 issue of the Journal of Clinical Ethics.