Consideration of surrogate decision-making processes in terminal care of patients with severe dementia

Abstract

With regard to family surrogate decision-making about terminal care, several studies have been conducted on “how to assist family surrogates in their decision-making.” However, there were few studies targeting surrogate decision-making itself prior to David Wendler et al.’s investigation encompassing “The Effect on Surrogates of Making Treatment Decisions for Others.” Still, this study was limited to statistical analyses, and there have been only a few studies focusing on individual cases. Therefore, the present study took a hermeneutic approach to dissecting individual cases and examining a methodology for analyzing psychological factors that influence decision-making in such cases. The possibility of facilitating agency decision-making was discussed. Specifically, we focused on family surrogate decision-making regarding “whether or not to administer artificial hydration and nutrition to a patient（AHN）with end-stage, severe dementia” and recorded all communications among family members, including non-verbal interactions, in order to perform conversation analyses. Through interpreting psychological and social factors affecting each family member, we were able to examine and analyze various factors that influence surrogate decision-making. Furthermore when a family shares the narrative for “surrogate decision-making”, we concluded that they can make a more suitable decision.