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Features for Senior Citizens
Female Relative Most Often Selected as Medical Proxy
by One-Third of Married People Who Don't Choose Spouse
Advance care planning
is not about documents it's about people and relationships
 July 26, 2006 - One-third of married individuals
choose someone other than their spouse as a surrogate for medical
decision-making. And more often than not, when adult patients chose a
parent, sibling or child, they prefer their mothers, sisters and
daughters to serve as medical proxies over their fathers, brothers and
sons.
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Feature for Senior Citizens |
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These are among the results of a study on advance
care planning conducted by Northwestern University researcher K. Michael
Lipkin, M.D., available in the online early edition of the Journal of
General Internal Medicine (Link
below story). Lipkin is assistant professor of clinical
preventive medicine at Northwestern University Feinberg School of
Medicine.
The finding that 33 percent of the married patients
in the study did not choose their spouse as surrogate is noteworthy,
because physicians regularly look to spouses as informal surrogates.
Additionally, over a quarter of survey participants
chose someone other than the person identified as an emergency contact
to act as proxy in medical decision-making.
"When patients choose a surrogate who is not the
person doctors would usually consult or who would not become empowered
as a substitute decision-maker under state laws, physicians are alerted
to engage these patients in an advance care planning process that
ensures the formal appointment of their desired health care agent,"
Lipkin said.
"Emphasis on end-of-life care, terminal illness and
the use or discontinuation of life-sustaining medical treatment [as in
the Terri Schiavo case] has obscured the need for advance planning in
the regular care of all competent adult patients," Lipkin said.
Lipkin commented that doctors do not ordinarily
consider advance planning unless patients are elderly or seriously ill.
At the same time, he and others have found, most patients are willing to
discuss plans for future medical care and are waiting for their
physicians "to begin the conversation and to raise the necessary
questions."
Lipkin designed and conducted a survey of over 300
participants to determine whether they were willing and able to
designate a specific person to act as a surrogate for medical
decision-making at the time of a routine health care appointment.
Study participants were of different ages (19 to 96
years) in various states of health, who were electively seeking medical
evaluation or treatment and who were considered competent to make their
own medical decisions.
Of the patients interviewed, over 90 percent
supported the idea of asking patients to designate a proxy for health
care on a routine basis. Yet, less than 26 percent of patients had
previously been asked to identify a surrogate in the course of ordinary
medical care.
When asked if they would want to name a proxy for
health care "now," that is, if their doctor asked them to at this
particular time, more than 85 percent answered "yes."
Lipkin said that identifying a proxy for health
care as part of routine medical inquiry offers several immediate
clinical advantages. First, the door is opened for ongoing advance care
planning discussions between patients and their doctors. Second, the
benefits of choosing a health care agent are made available to all
competent patients -- not only to the terminally ill, the very sick or
the very old. Third, documentation of a competent patient's proxy
preference in his/her medical record constitutes "clear and convincing
evidence" of prior patient wishes in case of incapacitation -- providing
a safety net until more definitive planning is accomplished.
Lipkin regards the routine identification of a
proxy for health care as a door-opening first step for ongoing
conversations between doctors, patients and families conversations
that emphasize the important relationships and values of patients and
their loved ones. The nature of this process encourages continuing
interchange, strengthens the patient's relationship with his/her
physician and promotes continuity of care.
"Advance care planning is not about documents -- it
is about persons and their relationships," Lipkin said.
Editor's Note - Participants for this study were
patients at the General Eye Clinic of the University of Chicago, where
Lipkin had been a faculty member of the Pritzker School of Medicine.
>> Story online at Journal of General Internal
Medicine -
click here
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