Relatives sometimes have to make decisions for others. But do these decisions reflect the patient’s will? A new study investigates this.
In the intensive care unit, patients are generally allowed to decide for themselves about the conduct of the necessary measures. But what happens if they are not able to do so, for example because their mental or physical condition does not permit it? In such cases, the relatives must make the decision. This can also involve measures that were not discussed beforehand—for example mechanical ventilation or organ donation after brain death. In the worst case, it could happen that relatives have to make decisions that the patients did not want.
The Study
The question of how well people are informed about the wishes of their relatives in the intensive care unit was investigated by researchers from the University Medical Center Hamburg-Eppendorf.
For this purpose, they interviewed patients on a ward as well as their relatives using an interview and a specially developed questionnaire. This included, among other things, questions about intensive care therapy—for example, whether they would accept artificial nutrition, an artificial heart, or an organ transplantation after brain death. It also dealt with ideas about quality of life: How important is mobility? Would it be acceptable to be permanently bedridden or fully dependent on external help? The aim of the study was to find out to what extent the relatives know the patients’ wishes or would decide in their sense.
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In most cases, they therefore aligned with the patients’ wishes. On average, the actual and the presumed patient will were in agreement in 4 out of 5 cases. However, there were clear differences depending on the measure: the highest concordance was with the administration of antibiotics or certain medications given in shock—as the body doesn’t receive enough oxygen. The lowest was with the artificial heart. Overall, only about one-third of respondents felt confident when answering the questions. About 60 percent of patients had discussed their wishes with relatives before treatment.
What’s the takeaway?
The study shows how important communication between patients, relatives, and medical staff is. Because incorrect assessments can lead to people being treated against their will. The study authors emphasize how important it is to share information about prognoses and possible complications of medical interventions transparently. In addition, the study provides starting points for further research on which methods are best suited to capture the wishes of patients who lack decision-making capacity.
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