The findings aren’t new to the bioethics literature, but it’s quite striking to read these two recent articles from Archives of Internal Medicine side-by-side. The first shows that patient-designated and next-of-kin surrogate decision makers incorrectly predict patients’ end-of-life treatment preferences in one-third of cases. Neither patient designation of the surrogate nor prior discussion of treatment preferences improved the surrogates’ accuracy. The second study shows patients’ treatment preferences changing as their health states change. Over time, patients who experience reductions in their abiltiy to perform activities of daily living are increasingly apt to rate treatments that result in disability as acceptable. Also, patients with pain were more apt to rate treatments resulting in pain as acceptable. This, as the abstract laconically puts it, “poses a challenge to advance care planning.”
-Stephen Latham