On the Likelihood of Surrogates Conforming to the Substituted Judgment Standard When Making End-of-Life Decisions for Their Partner

Abstract

A considerable proportion of end-of-life decisions are made by the patient’s next-of-kin, who can be asked to follow the substituted judgment standard and decide based on the patient’s wishes. The question of whether these surrogate decision makers are actually able to do so has become an important issue. In this study, we examined how the likelihood of surrogates conforming to the substituted judgment standard varies with individual differences in mortality acceptance and confidence in their decision making. We recruited 153 participants in romantic relationships between 18 and 80 years old from the general population. We asked them to make hypothetical end-of-life decisions for themselves and on behalf of their partner, as well as predict what their partner would do, and complete a series of questionnaires. Participants predicted that their partner would make similar decisions to their own but were more likely to accept a life-saving treatment that could result in reduced quality of life on their partner’s behalf than for themselves. Decisions made by older adults were more likely to conform to the substituted judgment standard, which is encouraging given that they are more likely to be confronted with these decisions in real life, although this was not due to differences in mortality acceptance. Older adults were also more likely to have had previous discussions with their partner and thereby know that person’s wishes and feel confident that they made the right decision, but these factors did not affect their likelihood of conforming to the substituted judgment standard. This shows that encouraging discussions about end of life among families would ease the decision process, but more work is needed to ensure that surrogates can adhere to the substituted judgment standard.

Do We Become More Cautious for Others When Large Amounts of Money Are at Stake?

“…This is also supported by findings in the medical domain, where people accept less risk for others (Batteux, Ferguson, & Tunney, 2019a;Polman & Wu, 2020). These show that, for others, people are more likely to choose a treatment to avoid a painful or deadly illness (Batteux, Ferguson, & Tunney, 2019c;Garcia-Retamero & Galesic, 2012), while also more likely to refuse a treatment involving a risk of death (Batteux, Ferguson, & Tunney, 2019b).…”

“…This is also supported by findings in the medical domain, where people accept less risk for others (Batteux et al, 2019a; Polman & Wu, 2020). These show that, for others, people are more likely to choose a treatment to avoid a painful or deadly illness (Batteux et al, 2019c; Garcia-Retamero & Galesic, 2012), while also more likely to refuse a treatment involving a risk of death (Batteux et al, 2019b). On the whole, it seems that people are motivated by avoiding a risk of death to a greater extent for others (Von Gunten & Scherer, 2018), even at the expense of their quality of life (Batteux et al, 2019c).…”

“…These show that, for others, people are more likely to choose a treatment to avoid a painful or deadly illness (Batteux et al, 2019c; Garcia-Retamero & Galesic, 2012), while also more likely to refuse a treatment involving a risk of death (Batteux et al, 2019b). On the whole, it seems that people are motivated by avoiding a risk of death to a greater extent for others (Von Gunten & Scherer, 2018), even at the expense of their quality of life (Batteux et al, 2019c). Most of these decisions could be considered mixed gambles, where choices involve both the possibility of a gain (e.g., recovering) and a loss (e.g., dying).…”

“…On the whole, it seems that people are motivated by avoiding a risk of death to a greater extent for others (Von Gunten & Scherer, 2018), even at the expense of their quality of life (Batteux et al, 2019c). Most of these decisions could be considered mixed gambles, where choices involve both the possibility of a gain (e.g.…”

Decision to Withdraw Life- Sustaining Treatments: The Experience of Thai Family Caregivers

“…They all reported feeling they lacked the necessary confidence to make such a decision since no legal documents for care preferences at the end of life had been established by any of the patients. Previous studies have found that early discussions about the end of life among family members could ease the decisionmaking process (Batteux et al, 2019(Batteux et al, , 2020. With such documents in place, relatives and family members tend to gain more confidence in making the right decisions that align with the patient's preferences.…”