Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2012 Dec;27(12):1657-65.
doi: 10.1007/s11606-012-2129-y. Epub 2012 Jul 28.

I don't want to be the one saying 'we should just let him die': intrapersonal tensions experienced by surrogate decision makers in the ICU

Yael Schenker  1 , Megan Crowley-Matoka, Daniel Dohan, Greer A Tiver, Robert M Arnold, Douglas B White
Affiliations
Comparative Study

I don't want to be the one saying 'we should just let him die': intrapersonal tensions experienced by surrogate decision makers in the ICU

Yael Schenker et al. J Gen Intern Med. 2012 Dec.

Abstract

Background: Although numerous studies have addressed external factors associated with difficulty in surrogate decision making, intrapersonal sources of tension are an important element of decision making that have received little attention.

Objective: To characterize key intrapersonal tensions experienced by surrogate decision makers in the intensive care unit (ICU), and explore associated coping strategies.

Design: Qualitative interview study.

Participants: Thirty surrogates from five ICUs at two hospitals in Pittsburgh, Pennsylvania, who were actively involved in making life-sustaining treatment decisions for a critically ill loved one.

Approach: We conducted in-depth, semi-structured interviews with surrogates, focused on intrapersonal tensions, role challenges, and coping strategies. We analyzed transcripts using constant comparative methods.

Key results: Surrogates experience significant emotional conflict between the desire to act in accordance with their loved one's values and 1) not wanting to feel responsible for a loved one's death, 2) a desire to pursue any chance of recovery, and 3) the need to preserve family well-being. Associated coping strategies included 1) recalling previous discussions with a loved one, 2) sharing decisions with family members, 3) delaying or deferring decision making, 4) spiritual/religious practices, and 5) story-telling.

Conclusions: Surrogates' struggle to reconcile personal and family emotional needs with their loved ones' wishes, and utilize common coping strategies to combat intrapersonal tensions. These data suggest reasons surrogates may struggle to follow a strict substituted judgment standard. They also suggest ways clinicians may improve decision making, including attending to surrogates' emotions, facilitating family decision making, and eliciting potential emotional conflicts and spiritual needs.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Enrollment flow chart.
None
None
None
See this image and copyright information in PMC

References

    1. Angus DC, et al. Use of intensive care at the end of life in the United States: an epidemiologic study. Crit Care Med. 2004;32(3):638–43. doi: 10.1097/01.CCM.0000114816.62331.08. - DOI - PubMed
    1. Thompson BT, et al. Challenges in end-of-life care in the ICU: statement of the 5th International Consensus Conference in Critical Care: Brussels, Belgium, April 2003: executive summary. Crit Care Med. 2004;32(8):1781–4. doi: 10.1097/01.CCM.0000126895.66850.14. - DOI - PubMed
    1. Carlet J, et al. Challenges in end-of-life care in the ICU. Statement of the 5th International Consensus Conference in Critical Care: Brussels, Belgium, April 2003. Intensive Care Med. 2004;30(5):770–84. doi: 10.1007/s00134-004-2241-5. - DOI - PubMed
    1. Vig EK, et al. Beyond substituted judgment: how surrogates navigate end-of-life decision-making. J Am Geriatr Soc. 2006;54(11):1688–93. doi: 10.1111/j.1532-5415.2006.00911.x. - DOI - PubMed
    1. Berger JT, DeRenzo EG, Schwartz J. Surrogate decision making: reconciling ethical theory and clinical practice. Ann Intern Med. 2008;149(1):48–53. - PubMed

Publication types