As the population ages and life-sustaining technologies improve, physicians will likely rely more heavily on surrogate decision-makers who "speak for the patient." This article outlines key issues affecting the physician-surrogate relationship and provides guidance for physicians who are making decisions with surrogates.
The authors argue that the physician and the surrogate must establish a unique relationship with each other that is very different from the traditional physician-surrogate relationship. They recommend that physicians who care for patients with diminished decision-making capacity pay attention to three specific aspects of their relationship with surrogates. First, before a crisis arises, the physician should work to build a relationship with the surrogate of a patient who lacks decision-making capacity. Second, the physician should assess how the surrogate's own grief and other intense emotions might influence decision-making and should support the surrogate through this difficult process. Third, physicians should approach decision-making as a process of consensus building.