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Opinions about surrogate designation: a population survey in France
Elie Azoulay1, Frédéric Pochard, Sylvie Chevret
1The French Famirea Study Group, Intensive Care Unit of the Saint-Louis Teaching Hospital, University Paris 7, Assistance Publique-Hôpitaux de Paris, Paris, France.
Objective:
Many patients go through periods when they are too ill to give consent or to participate in decisions. When this occurs, patient autonomy is best maintained when a surrogate designated by the patient and familiar with his or her values can speak for the patient. The objective of this study was to determine whether people who are not yet ill are ready to accept surrogate designation. Attitudes toward family participation in care were explored also.
Design:
Population survey by telephone. Because refusal of life-sustaining treatment is a dramatic example of patient autonomy, the survey used questions about ICU admission.
Setting:
General population in France.
Subjects:
Representative random sample of 8000 residents of France aged 18 yrs or more.
Interventions:
None.
Main Outcome Measures:
The survey investigated attitudes.
Results:
Most respondents said they would like to designate a surrogate (7205 [90%]) and to have their family share in their care (6691 [84%] for bathing, 5629 [70%] for feeding, and 4139 [52%] for tracheal suctioning) and in decisions about their management (6120 [76%]). Among respondents with a spouse, 79% said they would designate the spouse to speak for them. The attitudes were not influenced by ethnicity, religion or education level.
Conclusions:
Most people living in France would want a surrogate to represent them should they be incompetent and admitted to an ICU. Primary care physicians should inform their patients about the benefits of discussing illness-related issues among friends and family.