Life-support decisions are tough, but most surrogates want sole control

Stopping life-support for a critically ill and incapacitated person is not an easy decision. But a new study shows that about half of all surrogate decision-makers choose to maintain sole authority to make difficult end-of-life decisions.

The study was aimed at better understanding the processes by which people make life-support and treatment decisions for others that are loaded with moral and ethical uncertainty as well as emotional consequences. Researchers from the University of Pittsburgh surveyed 230 surrogate decision-makers of incapacitated patients who were in intensive care units and had a high likelihood of dying. The study participants were asked to respond to hypothetical situations regarding treatments for their loved ones.

They found that 55% of the surrogate decision-makers preferred to retain total control over decisions that involve ethical and moral questions, such as whether and when to withdraw life-support. But most of these individuals said they still wanted the doctor’s opinion.

Forty percent of the surrogates said they preferred sharing these decisions with doctors, and 5% said they would rather the doctor make the decision. The less trust the surrogate had in the doctor, the more likely the surrogate was to retain control over decisions. Men were less likely to cede their decision-making power.

“The vast majority of surrogates wish to be active participants in the decision-making process, though not all wish to have complete authority for the final decision,” the authors wrote. Doctors, they said, should ask surrogates to describe their preferred role in the decision-making process.

The study was published online Friday in the American Journal of Respiratory and Critical Care Medicine.

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