Surrogate decision-making and the need for advance care planning: issues raised by the Al Barnes case

Decisions regarding health care are increasingly difficult to make, especially as patients live longer and with more medical comorbidities. The case of Al Barnes, a man with advanced dementia who recently died in a Minnesota hospital despite months of aggressive care, illustrates the frequently encountered challenges that go along with making decisions about medical care for patients who lack the ability to do so themselves. These challenges can lead surrogates to opt for treatments that are efficacious but may be burdensome and inconsistent with the values, goals, or preferences the patient previously expressed either orally or in a written advance directive. In this article, we describe approaches that may help those who must make decisions for patients who cannot do so themselves and the merits and limitations of advance care planning.