title: The legal guardians' dilemma: Decision making associated with invasive non-life-saving procedures.
abstract: BACKGROUND
  ICU patients frequently undergo non-life-saving invasive procedures. When patient informed consent cannot be obtained, legal guardianship (LG), often from a close relative, may be required by law. The objective of this cohort study was to investigate the attitudes of LGs of ICU patients regarding the process of decision making for invasive non-life-saving procedures.
  
  
  METHODS
  The study was conducted from May 2009 until June 2010 in general medical/surgical ICUs in two large Israeli medical centers. All 64 LGs who met the study criteria agreed to participate in the study. Three questionnaires were administered: a demographic data questionnaire, the Family Satisfaction with ICU 34 Questionnaire, and the Attitudes towards the LG Decision Making Process questionnaire, developed by the authors.
  
  
  RESULTS
  The sample consisted of 64 LGs. Most participants were married (n = 56, 87.5%), male (n = 33, 51.6%), who had either a high school (n = 24, 37.5%) or college (n = 19, 29.7%) education, and were at a mean age of 49.2 (±11.22). Almost all of the procedures performed were tracheotomies (n = 63, 98.4%). About two-thirds of the LGs preferred decisions to be made by the medical staff after discussing options with them (n = 42, 65.6%) and about three-fifths stated that decisions could be made without the need for the appointment of an LG (n = 37, 57.8%). Attitudes towards ease of obtaining information and honesty of information were more positive compared to those of consistency and understanding of information.
  
  
  CONCLUSIONS
  The legal guardianship process requires better communication and more understandable information in order to assist LGs in making decisions for others in at times vague and stressful situations.
authors.affiliation: General ICU, Asaf HaRofeh Medical Center, Beer Jaacov 70300, Israel. kuniavsk.michael@mail.huji.ac.il.
authors.forename: Michael
authors.initials: M
authors.lastname: Kuniavsky
authors.forename: Freda Dekeyser
authors.initials: FD
authors.lastname: Ganz
authors.forename: David M
authors.initials: DM
authors.lastname: Linton
authors.forename: Sigal
authors.initials: S
authors.lastname: Sviri