Media Watch 522

Of special interest in the current issue of the weekly report:

How do clinicians prepare family members for the role of surrogate decision-maker?

JOURNAL OF MEDICAL ETHICS | Online – 17 July 2017 – Although surrogate decision-making (SDM) is prevalent in intensive care units (ICUs) and concerns with decision quality are well documented, little is known about how clinicians help family members understand the surrogate role. The authors investigated whether and how clinicians provide normative guidance to families regarding how to function as a surrogate. They audio-recorded and transcribed 73 ICU family conferences in which clinicians anticipated discussing goals of care for incapacitated patients at high risk of death. The authors developed and applied a coding framework to identify normative statements by clinicians regarding what considerations should guide surrogates’ decisions, including whether clinicians explained one or more of Buchanan and Brock’s (1989) three standard principles of SDM to family members. Clinicians did not provide normative guidance about the surrogate role in two-thirds of family conferences for incapacitated patients at high risk for death. When they did, clinicians’ guidance was often incomplete and sometimes conflicted with standard principles of SDM.