Magazine article Clinical Psychiatry News

New Tools Developed for End-of-Life Issues

Magazine article Clinical Psychiatry News

New Tools Developed for End-of-Life Issues

Article excerpt

PHILADELPHIA--Two new ways of dealing with end-of-life issues--default surrogates and physician-ordered life-sustaining treatment orders--are becoming more common in hospitals, according to several legal experts.

So far, 37 states have passed default surrogate regulations, aimed at naming a person who can act on behalf of an incapacitated hospital patient who does not have an advance directive, said Nina Kohn of Syracuse (N.Y.) University's College of Law. The vast majority of Americans--especially minorities, those with lower education levels, and younger patients--do not have an advance directive, noted Ms. Kohn, who spoke at a meeting of the American Society of Law, Medicine, and Ethics.

The states that have passed the default surrogate statutes "create a priority list saying if there is not an appointed surrogate, first the spouse does it, then the parent, then an adult sibling, and so on," she explained. "The common justification is the idea that the statutes help protect wishes of the incapacitated person."

But does that really work? Ms. Kohn and her associate Jeremy Blumenthal, also of Syracuse University, have been studying whether the laws result in the selection of the surrogates that incapacitated patients would have selected for themselves, and whether those surrogates made the decisions that those patients would have made.

They found that Americans tend to favor close family members as surrogates, which is consistent with most of the state laws. On the other hand, said Ms. Kohn, "The priority lists don't account for a number of factors predictive of surrogate selection, such as surrogate gender. Women are disproportionately selected as surrogates." In addition, the statutes "don't do a good job of accounting for nontraditional family structures such as same-sex couples, or [situations] where people have more inclusive or more intergenerational notions of families." This is particularly true of African Americans, who are less likely than are members of other racial groups to select a spouse or adult child as a surrogate, according to studies, she said.

As to whether the surrogates are deciding things the same way the patients would have, "we can't know for sure . …

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