Validation of the Health Care Surrogate Preferences Scale (Health Care Industry‪)‬

Advancing medical technology and increasing numbers of incapacitated patients in hospitals and nursing homes have augmented cultural demands to use technology to extend the lives of dying patients (Fletcher, Lombardo, Marshall, & Miller, 1997). In the United States, end-of-life treatment decisions have been examined through the lens of individual patient autonomy (American College of Obstetricians and Gynecologists, 1996; Hardwig, 1993; Keigher, 1994). In today's health care environment, a dual emphasis on cost containment and patient's rights fuels speculation on the types of medical care and treatment available to patients and their surrogates (Kapp, 2001). Although patients prefer family members as surrogates (Hines et al., 2001), they are reluctant to discuss treatment preferences in advance, as evidenced by relatively low rates of advance directive completion (from 10 percent to 25 percent; Dubler, 1995). Although elderly people without family may choose professionals as surrogates (High, 1990), when physician-family member surrogacy was compared, physicians made decisions consistent with their formal medical roles, not as surrogates ethically bound to follow ex pressed patient wishes; family members typically felt greater burdens when making decisions, yet identified more with patient preferences (Silberfeld, Grundstein, Stephens, & Deber, 1996). To date, research interest has focused on decisions of medical patients rather than on those of health care surrogates responsible for making from 60 percent to 90 percent of intensive care treatment decisions (Hines et al.; Swigart, Lidz, Butterworth, & Arnold, 1996).