• J Suhl, P Simons, T Reedy, and T Garrick.
• Department of Medicine, West Los Angeles Veterans Affairs Medical Center, Calif.
• Arch Intern Med. 1994 Jan 10;154(1):90-6.

ObjectiveTo identify factors predicting the accuracy of surrogate decision making in life support decisions.DesignQuestionnaire.SettingUrban Veterans Affairs hospital.Patients And DesignFifty hospitalized patients and their chosen surrogates were given questionnaires describing life support modalities and four common medical scenarios in which life support would be contemplated. An additional 50 patients also completed the questionnaire. Patients gave their choices of life support in the different scenarios. Surrogates guessed the patients' answers (substituted judgment). Details of the patient-surrogate relationship were asked. Patients completed a depression inventory.Main ResultsSurrogates correctly guessed patients' wishes about life support overall on 59.3% of the questions, not better than random chance (kappa = .09). The only predictor of accurate surrogate decision making was specific discussion between patient and surrogate about life support. SECONDARY RESULTS: Patients had an overall low desire for life support (35%), and a majority favored euthanasia under some circumstances (62%). There was no relationship between depression score and desire for life support.ConclusionsSubstituted judgment by surrogates is not more accurate than random chance. Discussion between patient and surrogate about life support correlated with more accurate substituted judgment.

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