NCPA - National Center for Policy Analysis


March 21, 2006

Surrogates designated to make medical decisions for patients correctly predict their preferences about two-thirds of the time, according to an analysis published in the Archives of Internal Medicine.

For the analysis, researchers pooled data from 16 role-playing studies in which 2,595 pairs of volunteer patients and their designated surrogates faced 151 hypothetical scenarios. For each scenario, researchers asked surrogates to decide whether the patients would want a medical intervention and separately asked patients about their preferences.

  • Surrogates correctly predicted the preferences of patients 68 percent of the time, the analysis finds.
  • Surrogates are supposed to consider not what they think would be best for the patient but what they believe the patient would want, which works only if surrogates get it right.
  • Under current law, patients can designate surrogates to make medical decisions for them in the event of incapacitation, and most states ask the next of kin to make such decisions when surrogates are not designated.

Lead study author David Wendler of NIH says we need to see if we can come up with a plausible alternative to the designation of surrogates to make medical decisions for patients.

Peter Ditto, a social psychologist at the University of California-Irvine, says the results of the study indicate that many patients change their preferences on medical decisions over time, adding, "It's kind of a moving target. It's one of the psychological limitations of things like advanced directives." He says, "End-of-life scenarios are much more complicated than people imagine at first. I do think we should look for more creative ways of doing this"

Source: Rick Weiss, "Patients' Surrogates Often Wrong About Preferred Treatment," Washington Post, March 14, 2006.

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