Decision-making capacity and surrogate designation in French ICU patients.
OBJECTIVE
To evaluate the capacity and willingness of French-speaking patients to designate a surrogate within 24 h of their ICU admission. French laws fail to indicate what should be done when an otherwise legally competent patient transiently loses his decision-making capacity.


METHODS
Surrogate designation was prospectively evaluated during two study periods. Only conscious patients were assessed using the Glasgow Come Score in the first study period, and all admitted patients were assessed in the second period. Decision-making capacity was evaluated using the Mini Mental Status Examination (MMSE) in the second study period.


METHODS
Twenty six-bed intensive care unit (ICU) in a French teaching hospital.


METHODS
Over a 8-month period 495 patients were included in the study, 415 in the first study period and 80 in the second.


RESULTS
Of the 495 patients 185 (37.3%) were interviewed, and 62.7% designated a surrogate. The surrogate was the spouse in 50% of cases and a child in 28.4%. Only 25.8% were considered to have decision-making capacity; 78.1% of competent patients and 28% of the patients without decision-making capacity agreed to designate a surrogate.


CONCLUSIONS
Surrogate designation by a patient should be evaluated in the light of the decision-making capacity of the patient. The traditional French paternalism still practiced by many French physicians appears out of tune with the wishes of their patients. We suggest that there is a need for developing a simple and effective tool for assessing decision-making capacity in ICU patients.
Ferrand
E
E
Surgical Intensive Care Unit of the Henri Mondor University Hospital, 51 rue du Mal de Lattre de Tassigny, 94010 Créteil cedex, France. edouard.ferrand@hmn.ap-hop-paris.fr
Bachoud-Levi
A C
AC
Rodrigues
M
M
Maggiore
S
S
Brun-Buisson
C
C
Lemaire
F
F
D000368:Aged; D001294:Attitude to Health; D003244:Consciousness Disorders / Q000175:diagnosis; D003657:Decision Making; D005260:Female; D005602:France; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D016743:Mental Competency; D008875:Middle Aged; D011446:Prospective Studies; D019727:Proxy; D011569:Psychiatric Status Rating Scales; D020458:Third-Party Consent