"Reconceptualizing How to Support Surrogates Making Medical Decisions for Critically Ill Patients"

Making medical decisions on behalf of hospitalized patients who lack decisional capacity can be extraordinarily stressful for family members acting as their surrogates. In a 2011 review of 40 studies that included 2854 surrogates who made treatment decisions, the majority of which were end-of-life decisions, a third reported lasting psychological trauma associated with the experience.1 Patients, too, may experience harm if surrogates make decisions that are not consistent with their values and preferences.
Many clinicians may consider that the best way to support surrogate decision makers is to focus on providing them the medical information needed to make informed choices, based on the assumption that good decisions will reliably flow from good information. However, this approach has repeatedly failed to influence treatment intensity at the end of life or lessen the psychological distress experienced by surrogates,2 probably because it overlooks key aspects of what makes the surrogate role so difficult.