Michael Gordon, MSc, MD, FRCPC
Vice President Medical Services
and Head, Geriatrics and Internal Medicine,
Baycrest Centre for Geriatric Care,
Professor of Medicine,
University of Toronto,
Toronto, ON.
What do you do when you are having problems communicating with the surrogate decision-maker of one of your dependent long-term care patients? It is not uncommon for health care providers to have conflicts with surrogates. Often it is about relatively minor, easily rectifiable issues, such as deciding who will be the official spokesperson for a large family, many members of which want to receive information or have their individual concerns addressed. Sometimes such a conflict may force staff to suggest that, if the family cannot make a decision amongst themselves, a legal solution will be sought. Most families will find ways to agree on decision-making, rather than leaving such important decisions to outsiders such as court-appointed guardians.
Unfortunately, the challenges that are sometimes posed by surrogates can leave even the most experienced clinical staff in turmoil. Some years ago, the nursing and medical staff of a palliative care unit appealed to the Baycrest ethics committee to intervene, on behalf of their patient, between themselves and the patient's surrogate spouse, with whom they were having serious problems.
