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Decisional Incapacity and the Prevalence of Surrogate Decision Makers

14 Pages Posted: 27 Aug 2019

See all articles by Jennifer Tseng

Jennifer Tseng

University of Chicago - Department of Surgery

Erin S. DeMartino

University of Chicago - MacLean Center for Clinical Medical Ethics; Mayo Clinic - Division of Pulmonary and Critical Care

Jacob R. Peschman

Mayo Clinic - Biomedical Ethics Research Program

Nicholas A. Braus

Mayo Clinic - Division of Pulmonary and Critical Care; University of Chicago - MacLean Center for Clinical Medical Ethics

Betsy L. Gammon

Mayo Clinic - Biomedical Ethics Research Program

Paul S. Mueller

Mayo Clinic - Biomedical Ethics Research Program

Michael P. Bannon

Mayo Clinic - Department of Surgery

Mark Siegler

University of Chicago - Pritzker School of Medicine

Andrew Hantel

University of Chicago - Pritzker School of Medicine; University of Chicago - MacLean Center for Clinical Medical Ethics

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Abstract

BACKGROUND: In patients who lack temporary or permanent decisional capacity, substituted judgment by surrogates is necessary. However, the current prevalence of surrogate decision making in the inpatient setting is unknown. The goal of this study was to better quantify how often surrogate decision makers are relied upon in the care of Medicine and Surgery inpatients.

METHODS: We performed interviews of health care providers who cared for Medicine and Surgery inpatients on the acute care units and intensive care units (ICUs) of the University of Chicago Medical Center in Chicago, Illinois and Mayo Clinic Hospital in Rochester, Minnesota on a chosen date. We obtained information regarding the number of inpatients who lacked decisional capacity and how many had a surrogate decision maker.

RESULTS: At University of Chicago and Mayo Clinic, 15% of Medicine inpatients and 12% of Surgery inpatients lacked decisional capacity. Eighty-five percent of the Medicine inpatients and 75% of the Surgery inpatients that lacked decisional capacity had a surrogate decision maker. A greater proportion of inpatients in the ICU setting (40% of Medicine inpatients and 45% of Surgery inpatients at University of Chicago and 32% of Medicine inpatients and 41% of Surgery inpatients at Mayo Clinic) lacked decisional capacity.

CONCLUSIONS: This is the first study to quantify the extent of surrogate decision making in the inpatient setting at two major academic medical centers in the United States. At any given time, up to 15% of inpatients and 40% of ICU patients lack decisional capacity. Healthcare providers should routinely encourage patients to name a surrogate decision maker in the event of unforeseen future circumstances preventing them from making their own medical decisions.

FUNDING STATEMENT: None.

DECLARATION OF INTERESTS: The authors stated: "No relevant disclosures."

ETHICS APPROVAL STATEMENT: The study received Institutional Review Board exemption at both the University of Chicago and Mayo Clinic.

Suggested Citation

Tseng, Jennifer and DeMartino, Erin S. and Peschman, Jacob R. and Braus, Nicholas A. and Gammon, Betsy L. and Mueller, Paul S. and Bannon, Michael P. and Siegler, Mark and Hantel, Andrew, Decisional Incapacity and the Prevalence of Surrogate Decision Makers (08/15/2019 00:36:40). Available at SSRN: https://ssrn.com/abstract=3439557 or http://dx.doi.org/10.2139/ssrn.3439557

Jennifer Tseng (Contact Author)

University of Chicago - Department of Surgery ( email )

United States

Erin S. DeMartino

University of Chicago - MacLean Center for Clinical Medical Ethics

5841 S Maryland Ave
Chicago, IL 60637-1470
United States

Mayo Clinic - Division of Pulmonary and Critical Care

Rochester, MN
United States

Jacob R. Peschman

Mayo Clinic - Biomedical Ethics Research Program

Rochester, MN
United States

Nicholas A. Braus

Mayo Clinic - Division of Pulmonary and Critical Care

Rochester, MN
United States

University of Chicago - MacLean Center for Clinical Medical Ethics

5841 S Maryland Ave
Chicago, IL 60637-1470
United States

Betsy L. Gammon

Mayo Clinic - Biomedical Ethics Research Program

Rochester, MN
United States

Paul S. Mueller

Mayo Clinic - Biomedical Ethics Research Program

Rochester, MN
United States

Michael P. Bannon

Mayo Clinic - Department of Surgery

200 First Street SW
United States

Mark Siegler

University of Chicago - Pritzker School of Medicine ( email )

Chicago, IL 60637
United States

Andrew Hantel

University of Chicago - Pritzker School of Medicine

Chicago, IL 60637
United States

University of Chicago - MacLean Center for Clinical Medical Ethics

5841 S Maryland Ave
Chicago, IL 60637-1470
United States

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