An empirical study of surrogates' preferred level of control over value-laden life support decisions in intensive care units
| Autor: | Lisa A. Weissfeld, Douglas B. White, Christopher A. Bautista, Sara K. Johnson, Seo Yeon Hong |
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| Rok vydání: | 2010 |
| Předmět: |
Pulmonary and Respiratory Medicine
Adult Male Multivariate analysis Critical Care Critical Illness education Decision Making Critical Care and Intensive Care Medicine Life Support Care Cohort Studies Empirical research C. Critical Care Nursing Informed consent Professional-Family Relations Intensive care Odds Ratio Medicine Humans Prospective Studies Aged Withholding Treatment Informed Consent business.industry Middle Aged Proxy Intensive Care Units Life support Multivariate Analysis Female business End-of-life care |
| Zdroj: | American journal of respiratory and critical care medicine. 183(7) |
| ISSN: | 1535-4970 |
| Popis: | Despite ongoing ethical debate concerning who should control decisions to discontinue life support for incapacitated, critically ill patients, the perspectives of surrogate decision makers are poorly understood.To determine (1) what degree of decisional authority surrogates prefer for value-sensitive life support decisions compared with more technical biomedical decisions, and (2) what predicts surrogates' preferences for more control over life support decisions.This was a prospective study of 230 surrogate decision makers for incapacitated, mechanically ventilated patients at high risk of death. Surrogates reported their preferred degree of decisional authority using the Degner Control Preferences Scale for two types of decisions: a value-sensitive decision about whether to discontinue life support and a decision regarding which antibiotic to prescribe for an infection.The majority of surrogates (55%, 127/230; 95% confidence interval, 49-62%) preferred to have final control over the value-sensitive life support decision; 40% (91/230) wished to share control equally with the physician; 5% (12/230) of surrogates wanted the physician to make the decision. Surrogates preferred significantly more control over the value-sensitive life support decision compared with the technical decision about choice of antibiotics (P0.0001). Factors independently associated with surrogates' preference for more control over the life support decision were: less trust in the intensive care unit physician, male sex, and non-Catholic religious affiliation.Surrogates vary in their desire for decisional authority for value-sensitive life support decisions, but prefer substantially more authority for this type of decision compared with technical, medical judgments. Low trust in physicians is associated with surrogates preferring more control of life support decisions. |
| Databáze: | OpenAIRE |
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