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Identifying medical proxy should be part of routine medical care

One-third of married individuals choose someone other than their spouse as a surrogate for medical decision-making. And more often than not, when adult patients chose a parent, sibling or child, they prefer their mothers, sisters and daughters to serve as medical proxies over their fathers, brothers and sons.

These are among the results of a study on advance care planning conducted by Northwestern University researcher K. Michael Lipkin, M.D., available in the online early edition of the Journal of General Internal Medicine (http://www.blackwell-synergy.com/toc/jgi/0/0). Lipkin is assistant professor of clinical preventive medicine at Northwestern University Feinberg School of Medicine.

The finding that 33 percent of the married patients in the study did not choose their spouse as surrogate is noteworthy, because physicians regularly look to spouses as informal surrogates.

Additionally, over a quarter of survey participants chose someone other than the person identified as an emergency contact to act as proxy in medical decision-making.

"When patients choose a surrogate who is not the person doctors would usually consult or who would not become empowered as a substitute decision-maker under state laws, physicians are alerted to engage these patients in an advance care planning process that ensures the formal appointment of their desired health care agent," Lipkin said.

"Emphasis on end-of-life care, terminal illness and the use or discontinuation of life-sustaining medical treatment [as in the Terri Schiavo case] has obscured the need for advance planning in the regular care of all competent adult patients," Lipkin said.

Lipkin commented that doctors do not ordinarily consider advance planning unless patients are elderly or seriously ill. At the same time, he and others have found, most patients are willing to discuss plans for future medical care and are waiting for
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Contact: Elizabeth Crown
e-crown@northwestern.edu
312-503-8928
Northwestern University
26-Jul-2006


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