BMC Medical Ethics 22 (1):1-12 (2021)
AbstractBackgroundIn the coming years, surrogate decision-making is expected to become highly prevalent in Japanese clinical practice. Further, there has been a recent increase in activities promoting advance care planning, which potentially affects the manner in which judgements are made by surrogate decision-makers. This study aims to clarify the grounds on which surrogate decision-makers in Japan base their judgements.MethodsIn this qualitative study, semi-structured interviews were conducted to examine the judgement grounds in surrogate decision-making for critical life-sustaining treatment choices in acute care hospitals.ResultsA total of 228 participants satisfied the inclusion criteria, and 15 were selected for interviews. We qualitatively analysed the content of 14 interview transcripts, excluding one that did not meet the inclusion criteria. Based on this analysis, we extracted 4 core categories, 17 categories, 35 subcategories, and 55 codes regarding judgement grounds in surrogate decision-making. The four core categories were as follows: patient preference-oriented factor, patient interest-oriented factor, family preference-oriented factor, and balanced patient/family preference-oriented factor. The Type 4 core category represented attempts to balance the preferences of the patient with those of the surrogate decision-maker.ConclusionsSurrogate decision-makers based their decisions on important aspects related to a patient’s life, and they considered not only the patient’s preferences and best interests but also their own preferences. As the need for surrogate decisions will increase in the future, decision-makers will need to consider judgement grounds from a more diverse perspective.
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References found in this work
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How Do Clinicians Prepare Family Members for the Role of Surrogate Decision-Maker?V. Cunningham Thomas, P. Scheunemann Leslie, M. Arnold Robert & White Douglas - 2018 - Journal of Medical Ethics 44 (1):21-26.
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How do clinicians prepare family members for the role of surrogate decision-maker?T. V. Cunningham, L. P. Scheunemann, R. M. Arnold & D. White - 2017 - Journal of Medical Ethics Recent Issues 44 (1):21-26.
Matters to address prior to introducing new life support technology in Japan: three serious ethical concerns related to the use of left ventricular assist devices as destination therapy and suggested policies to deal with them.Atsushi Asai, Sakiko Masaki, Taketoshi Okita, Aya Enzo & Yasuhiro Kadooka - 2018 - BMC Medical Ethics 19 (1):12.
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