Seventy percent of Americans age 60 or over requiring decisions about medical treatment in the final days of life lack capacity to make these decisions. The biggest life-and-death decisions of their lives—literally—had to be made by someone else. Yet despite their critical role, we know remarkably little about these surrogate decision makers, the process they follow, the criteria they consider, the choices they make, and the challenges they face. Drawing on observations of two diverse intensive care units, day after day, for more than two years, this book exposes how and why surrogates navigat ... More

Seventy percent of Americans age 60 or over requiring decisions about medical treatment in the final days of life lack capacity to make these decisions. The biggest life-and-death decisions of their lives—literally—had to be made by someone else. Yet despite their critical role, we know remarkably little about these surrogate decision makers, the process they follow, the criteria they consider, the choices they make, and the challenges they face. Drawing on observations of two diverse intensive care units, day after day, for more than two years, this book exposes how and why surrogates navigate this grueling role and the impact of the course they fashion. Readers will learn how decision makers are selected, the interventions they weigh in on, the information they seek and evaluate, the values and memories they draw on, the criteria they weigh, the outcomes they choose, the conflicts they become embroiled in, and the challenges they face. Observations also provide insight into why some decision makers authorize one aggressive intervention after the next while others do not—even on behalf of patients with similar problems and prospects. And they expose the limited role of advance directives in structuring the process decision makers follow or the outcomes that result. These findings provide important lessons to future patients, their loved ones and surrogates; those who serve, counsel, or care for those as they near life’s end and their families (physicians, nurses, chaplains, social workers, and lawyers); and scholars, bioethicists, and health policy makers as well.