Substituted Judgment and the Decision to Withhold Life Support
Authors: Kenneth N. Scissors, Colleen Butler Scissors
Journal: Annals of Internal Medicine (1991)

Letters1 November 1991Substituted Judgment and the Decision to Withhold Life SupportKenneth N. Scissors, MD, Colleen Butler Scissors, JDKenneth N. Scissors, MDSearch for more papers by this author, Colleen Butler Scissors, JDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-115-9-743 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the Editors: The results of the provocative study by Seckler and colleagues (1) lack generalizability because of two major flaws in the study design. The investigators' choice of study setting, an urban geriatrics teaching clinic, introduces pre-selection bias into the study, and their use of a single-interviewer method creates an uncontrolled confounder (2).In contrast to patients in previous studies (3), most of those (67%) in the study by Seckler and colleagues answered "yes" when asked whether they wanted to be resuscitated if they were no longer able to recognize family and friends and if they had a sudden...References1. SecklerMeierMulvihillCammer Paris ADMB. Substituted judgment: how accurate are proxy predictions? Google Scholar2. Sackett D. How to read clinical journals. Can Med Assoc J. 1981; 124:555-8. MedlineGoogle Scholar3. Emanuel L. Advance directives for medical care: a case for greater use. N Engl J Med. 1991;324:889-95. CrossrefMedlineGoogle Scholar4. ParisReardon JF. The AMA's guidelines on DNR policy: conflict over patient autonomy, family consent, and physician responsibility. Clin Ethics Report. 1991;5:1-6. Google Scholar5. Miles S. Informed demand for ''non-beneficial'' medical treatment. N Engl J Med. 1991;325:512-5. CrossrefMedlineGoogle Scholar1. SecklerMeierMulvihillCammer Paris ADMB. Substituted judgment: how accurate are proxy predictions? Ann Intern Med. 1991;115:92-8. LinkGoogle Scholar2. . Deciding to Forego Life-Sustaining Treatment, v. 1. Washington, DC: U.S. Government Printing Office; 1983:136. Google Scholar3. Article 29-B of N.Y. Public Health Law, section 2965(5)(a). Google Scholar4. WeirGostin RL. Decisions to abate life-sustaining treatment for nonautonomous patients: ethical standards and legal liability for physicians after Cruzan. JAMA. 1990;264:1846. CrossrefMedlineGoogle Scholar1. SecklerMeierMulvahillCammer Paris ADMB. Substituted judgment: how accurate are proxy predictions? Ann Intern Med. 1991;115:92-8. LinkGoogle Scholar2. Cruzan v. Director, Missouri Department of Health, 110 S. Ct. 2841 (1990). Google Scholar3. Wigton R. Applications of judgment analysis and cognitive feedback to medicine. In Brehmer B, Joyce CRB; eds. Human Judgment: the SJT view. Amsterdam: Elsevier Science Publishers B.V.; 1988;227-245. CrossrefGoogle Scholar4. EmanuelEmanuel LE. The medical directive: a new comprehensive advance care document. JAMA. 1989;261:3288-93. CrossrefMedlineGoogle Scholar5. Gibson J. National values history project: what traditional advanced directives have overlooked. Generations. 1990;14(Suppl):51-64. MedlineGoogle Scholar1. SecklerMeierMulvihillCammer Paris ADMB. Substituted judgment: how accurate are proxy predictions? Ann Intern Med. 1991;115:92-8. LinkGoogle Scholar1. SecklerMeierMulvihillCammer Harris ADMB. Substituted judgment: how accurate are proxy predictions? Ann Intern Med. 1991;115:92-8. LinkGoogle Scholar1. SecklerMeierMulvihillCammer Paris BDMB. Substituted judgement: how accurate are proxy predictions? Ann Intern Med 1991;115:92-8. LinkGoogle Scholar2. UhlmannPearlmanCain RRK. Physicians' and spouses' predictions of elderly patients' resuscitation preferences. J Gerontol. 1988;43:115-21. CrossrefMedlineGoogle Scholar3. . Deciding to Forego Life-Sustaining Treatment, v. 1. Washington DC: U.S. Government Printing Office; 1983:136. Google Scholar4. EmanuelEmanuel LE. The medical directive: a new comprehensive care document. JAMA. 1989;261:3288-93. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: Kenneth N. Scissors, MD; Colleen Butler Scissors, JDAffiliations: 1710 NE Stanton Avenue Portland, OR 97212 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byLegislating how critical care physicians discuss and implement do-not-resuscitate ordersThe Family's Will or the Living Will: Patient Self-Determination in Doubt 1 November 1991Volume 115, Issue 9Page: 743-745KeywordsGeriatrics ePublished: 1 December 2008 Issue Published: 1 November 1991 PDF downloadLoading ...