Abstract
BackgroundICU patients frequently undergo non-life-saving invasive procedures. When patient informed consent cannot be obtained, legal guardianship (LG), often from a close relative, may be required by law. The objective of this cohort study was to investigate the attitudes of LGs of ICU patients regarding the process of decision making for invasive non-life-saving procedures.MethodsThe study was conducted from May 2009 until June 2010 in general medical/surgical ICUs in two large Israeli medical centers. All 64 LGs who met the study criteria agreed to participate in the study. Three questionnaires were administered: a demographic data questionnaire, the Family Satisfaction with ICU 34 Questionnaire, and the Attitudes towards the LG Decision Making Process questionnaire, developed by the authors.ResultsThe sample consisted of 64 LGs. Most participants were married (n = 56, 87.5%), male (n = 33, 51.6%), who had either a high school (n = 24, 37.5%) or college (n = 19, 29.7%) education, and were at a mean age of 49.2 (±11.22). Almost all of the procedures performed were tracheotomies (n = 63, 98.4%). About two-thirds of the LGs preferred decisions to be made by the medical staff after discussing options with them (n = 42, 65.6%) and about three-fifths stated that decisions could be made without the need for the appointment of an LG (n = 37, 57.8%). Attitudes towards ease of obtaining information and honesty of information were more positive compared to those of consistency and understanding of information.ConclusionsThe legal guardianship process requires better communication and more understandable information in order to assist LGs in making decisions for others in at times vague and stressful situations.
Highlights
ICU patients frequently undergo non-life-saving invasive procedures
If any one or more of five interventions are indicated, consent is obtained from a relative who has power of attorney or is a legal proxy of the patient for bodily issues; if none are available, a legal guardian must be appointed for the patient by the courts, in order to give a written informed consent for the intervention on behalf of the patient
Inclusion criteria were legal guardianship (LG) of ICU patients who could not provide informed consent and required non-life-saving invasive procedures and who were able to complete a questionnaire in the Hebrew language
Summary
ICU patients frequently undergo non-life-saving invasive procedures. When patient informed consent cannot be obtained, legal guardianship (LG), often from a close relative, may be required by law. If any one or more of five interventions are indicated (non-life saving surgical procedures, angioplasty, dialysis, radiotherapy, chemotherapy, and in vitro fertilization), consent is obtained from a relative who has power of attorney or is a legal proxy of the patient for bodily issues; if none are available, a legal guardian must be appointed for the patient by the courts, in order to give a written informed consent for the intervention on behalf of the patient. In this situation, the legal guardian is acting as a legal stand-in for the patient. This relates to understanding the implications of the decision, including any undesired side-effects or complications, but does not absolve the clinician of any negligence liability
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