In another investigation, researchers in England constructed an empirical exploration of “what people want in a decision-maker whom they themselves select.” For the study, 30 undergraduate students were presented with a hypothetical scenario proposing that they were expected to lose mental capacity in the future and asking that they consider whom they would choose as surrogate.

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Although the majority of the subjects said they would choose someone who was caring and competent, only a few of them stressed how important it was for the surrogate to know their preferences with regard to making important treatment decisions. The study participants were more concerned with the surrogate’s social role, honesty, and loyalty than with the attitudes and values they had in common.4 However, studies conclude that everyone involved in the process derives maximum benefit and experiences reduced stress if the patient selects a surrogate early; if the patient explains his or her treatment preferences; and if the patient, physician, and surrogate share in the decision-making process.


In a recent study on advance care planning, Iowa gerontologists acknowledged that, by law, older patients must be able to determine their own health care. Although seniors often have the mental capacity to make their own significant treatment and end-of-life decisions, sometimes they do not. Older adults should plan for the possibility of losing their mental capacity. To do so, they should select a surrogate and discuss with him or her which decisions they would like that person to make for them. This should occur as part of advance care planning.5Documenting and then sharing these treatment preferences on an advance directive can further help patients guide their own health care and reduce the surrogate’s burden.


Choosing a health care surrogate is not an easy decision, and it can certainly be stressful for the patient and surrogate alike. Despite these challenges, the consensus of the studies reviewed was that, although it is difficult to make end-of-life decisions for someone else, most surrogates find their roles satisfying.2 Moreover, quite a few of them felt that they had “honored their loved ones’ wishes and values.”1 ONA

Bette Kaplan is a medical writer based in Tenafly, New Jersey.


1. The trauma of surrogacy. Pallimed: A Hospice & Palliative Medicine Blog. Accessed September 20, 2011.

2. Wendler D, Rid A. Systematic review: The effect on surrogates of making treatment decisions for others. Ann Intern Med. 2011;154(5):336-346.

3. Hauke D, Reiter-Theil S, Hoster E, et al. The role of relatives in decisions concerning life-prolonging treatment in patients with end-stage malignant disorders: informants, advocates or surrogate decision-makers? [published online ahead of print March 21, 2011]. Ann Oncol.

4. Edwards SJ, Brown P, Twyman MA, et al. A qualitative investigation of selecting surrogate decision-makers [published online ahead of print May 27, 2011]. J Med Ethics.

5. Gittler J. Advance care planning and surrogate health care decision making for older adults. J Gerontol Nurs. 2011;37(5):15-19.