Patients' preferences concerning medical information and surrogacy: results of a prospective study in a French emergency department

Abstract

Our patients expressed a strong desire to receive extensive information should they become seriously ill, and two-thirds of them reported they would want a surrogate. However, only 40.6 % of the patients living with a spouse/partner would want their spouse/partner to be their surrogate. These data suggest that the time has probably come to propose a nation-wide public hearing on medical information and surrogacy in France.

What are the ethical issues in relation to the role of the family in intensive care?

“…The objective of identifying a person with these qualities is to avoid what regularly happens in routine practice, namely "automatic" designation of the spouse as the intermediary. Indeed, the spouse is not always the most appropriate person to act as a reference in the context of ICU care, in the same way as a surrogate designated on the spur of the moment during the hospitalisation is not always prepared for the task entrusted to them (28,29).…”

Ethical challenges involved in obtaining consent for research from patients hospitalized in the intensive care unit

“…Nonetheless, when no official surrogate has been designated by the patient, the care-giving team in the ICU may have difficulty identifying a suitable person in the patient's entourage with whom to interact, or from whom to request consent for research, for example. Indeed, choosing the spouse, which is often the default position, may not be the most suitable choice in the patient's view (28,29). Several characteristics among the persons attending the patient may help the physicians and ICU staff to identify the most suitable surrogate, such as knowledge of the patient's wishes, the nature of their bond with the patient, and an adequate level of understanding (30).…”

End-of-life patients, intensive care and consent

“…But clinical experience shows that, like the issue of patient surrogates, the use of these advance directives may be problematic. Firstly, not all patients have prepared them or even discussed them with their family or friends prior to their admission into intensive care [28], and some patients prefer that their families make such decisions for them [29]. Secondly, when they are prepared, these advance directives cannot be precisely tailored to the end-of-life situation in which the patient ultimately finds himself, and some countries with experience of them question their viability [30][31][32].…”