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New paper on surrogate decision making published in BMJ Open
Posted on Thu, Aug 02 2018

If a patient is no longer able to express his or her treatment preferences (e.g., due to an accident or due to dementia), a surrogate may need to make medical decisions on behalf of this person. Such "surrogate decisions" are among the most difficult decisions under uncertainty that we have to make in our lives. So how to best make surrogate decisions?

In our previous research (Frey, Hertwig, & Herzog, 2014) we found that different approaches to surrogate decision making (e.g., a patient-designated surrogate; all family members rendering a joint decision; etc.) do not differ substantially in terms of their "predictive accuracy". Therefore, in our most recent paper published in the BMJ Open (Frey, Herzog, & Hertwig, 2018) we investigated people's "procedural preferences". That is, how strongly do people endorse different approaches to surrogate decision making?

The figure above shows the results from two representative population surveys that we conducted in Germany and Switzerland. People reported their procedural preferences for six different approaches to surrogate decision making, either from the perspective of an incapacitated patient or from the perspective of a potential surrogate for an incapacitated family member. Fortunately, the procedural preferences of potential "patients" and "surrogates" were mostly aligned. Yet, endorsements for the different approaches varied markedly (see figure). These findings may have direct implications for clinicians and policy makers, as current legislations only provide for individualistic approaches. You can learn more about this topic under my research section on medical decision making and by downloading our paper (open access) including the full set of results.

Frey, R., Herzog, S. M., & Hertwig, R. (2018). Deciding on behalf of others: A population survey on procedural preferences for surrogate decision-making. BMJ Open, 8, e022289. doi:10.1136/bmjopen-2018-022289 | PDF