Decisional Incapacity and the Prevalence of Surrogate Decision Makers

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.