Substituted Judgment: How Accurate Are Proxy Predictions?

摘要: Substituted judgment has been proposed as a method of promoting the autonomy mentally incapacitated patient, but little is known about accuracy surrogate decision makers in reflecting true wishes patients. In this study, makers' views (those primary care providers and close family members) were compared with decisions currently competent chronically ill elderly patients, using hypothetic cardiopulmonary resuscitation scenario under circumstances current health progressive dementia. Concordance between patients their surrogates was evaluated by assessing percent agreement, kappa coefficient (for concordance beyond chance), directionality discrepant responses. Most patient respondents chose to be resuscitated both scenarios. Although predicted that physicians (90%) members (87%) would accurately represent wishes, neither nor physicians, fact, able adequately predict patients' scenarios (kappa less than or equal 0.3 all scenarios; agreement range, 59% 88%). Few had ever discussed preferences either member (16%) physician (7%). These results cast doubt on usefulness strict substituted standard an approach medical making for diminished mental capacity.