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Page: << Prev | 1 | 2 Torke and her team interviewed 21 physicians at a Midwestern hospital, asking them to identify a time when they had to make a major surrogate decision.
The authors found that physicians do rely on standard legal and ethical guidelines but that their approaches were more complicated in two key ways.
"Physicians considered the wishes or needs of the surrogate or family in addition to those of the patient, and those aren't really accounted for in any of the ethical models. Nowhere does it say that it's OK to do something, because the parent's child tells you that's what they want, but, to some extent, that's what physicians do," Torke said.
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In one case, a patient died in the hospital even after expressing a desire to die at home. The family, however, felt they couldn't cope with at-home care, and the physician, although uncomfortable with the decision, still realized that the wishes and needs of the family needed to be taken into account.
Secondly, physicians also felt they had authorities in making decisions, even though traditionally this is the role of family members. "They have the clinical expertise and a sense of duty to the patient," Torke said. "They have a stake in determining what's best for the patient. It's part of their obligation."
One physician described a decision to not pursue treatment for a patient based on the extremely poor prognosis. "Going further with treatment like, you know, trach and G-tube and these sorts of things, and likely ventilator dependence, was just futile . . . just inappropriate, just not right for the patient."
Torke said she could think of two possible responses to her findings. One would be to direct physicians back to the existing guidelines. The other would be to give more consideration to real-life issues when formulating guidelines.
"It's very reasonable for us to examine that family input is important and should be valued," she said. "Maybe ethical models are too narrow, and maybe they should consider other factors as well."
More information
The American Geriatrics Society has more on end-of-life issues.
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