To have done everything

When a patient loses decisional capacity, the responsibility to make treatment decisions often falls on a family member who becomes the surrogate decision-maker. This case study provides an example of a situation where the medical team and the surrogate decision-maker initially disagreed on the best course of action for the patient. The ethicist was called in to lead a guided conversation to help the team and the surrogate decision-maker reach a consensus. This case illustrates the importance of allowing the surrogate decision-maker to ask clarifying questions and process their emotions before making a decision.

Factors Associated with Difficulties Faced by Ward Nurses When Providing Support to Families of Patients with Advanced Cancer in Surrogate Decision-making

This study aimed to describe the types of support that ward nurses provide to families of patients with advanced cancer in surrogate decision-making and the factors associated with the difficulties these nurses experienced . An anonymous self-administered questionnaire survey was conducted among 285 nurses practicing in the cancer wards of four facilities. In total, 230 (80.7%) nurses provided support in surrogate decision-making, such as attending discussions. Additionally, 41 (17.8%) of the respondents often experienced difficulties performing this task. Results of a binary logistic regression analysis showed that the factors associated with the nurses’ recognition of difficulties were frequency of surrogate decision-making support requirements (OR=2.41, P=0.009) and incomprehension of the relationships between patients and their families (OR=2.41, P=0.009). To promote nurses’ support in surrogate decision-making, we suggest routinely collecting information on the relationships between patients and their families.

Continue with ICU care – she is a spiritual being

This case study discusses a dispute between the healthcare team and the patient’s surrogate decision maker at a cancer centre. While the healthcare team deemed further care to be futile, the patient’s husband argued that they should continue to try to reverse his wife’s acute decline. This case study illustrates the inertia and moral distress that can result when there are differences between patients/surrogates and the healthcare team in their goals for intensive care. The issues of moral distress and an inability to make decisions were addressed by involving an ethics consultant, and by creating institutional mechanisms to address end-of-life issues at an earlier stage

Elderly people's thoughts about surrogate decision making in end-of-life care : Increasing trust through communication in the primary care / 日本プライマリ・ケア連合学会誌

<b>Introduction</b> : The purpose of this study was to approach issues related to end-of-life care by investigating elderly people's own thoughts about surrogate decision making by family members.<br><b>Methods</b> : Semi-structured interviews were carried out with 30 elderly people 60 years of age and older to determine whether or not they trust in surrogate decision making by their family members, and to examine the reasons for their thoughts. Each of the respondents' statements were categorized by level of confidence, and their reasons were analyzed.<br><b>Results</b> : Respondents were divided into two main groups : a “trusting” group and an “anxious” group. Seventy percent of respondents were in the “trusting” group. In both groups, the most common reason given was related to the desire to directly communicate one's wishes to one's surrogates. Following that, in the “trusting group”, the main reasons were related to the thoughts of the interviewee and the characteristics of the surrogates. In the “anxious group”, the main reasons were issues of end-of-life care related to the feelings of surrogates, the attitude of medical staff, and other background factors.<br><b>Conclusion</b> : To resolve issues of surrogate decision making related to end-of-life care, it is important in primary care practice to provide encouragement and support to elderly people to allow them to clearly communicate their wishes. We recommend further study and ethical discussion about end-of-life care to establish appropriate legal and institutional frameworks.