Objective: To evaluate the capacity and willingness of French-speaking pati
ents to designate a surrogate within 24 h of their ICU admission. French la
ws fail to indicate what should be done when an otherwise legally competent
patient transiently loses his decision-making capacity
Design: 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.
Setting: Twenty six-bed intensive care unit (ICU) in a French teaching hosp
ital.
Patients and participants: Over a 8-month period 495 patients were included
in the study, 415 in the first study period and 80 in the second.
Measurements and results: Of the 495 patients 185 (37.3 %) were interviewed
, and 62.7 % designated a surrogate. The surrogate was the spouse in 50 % o
f 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 wit
hout 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 Frenc
h 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 dev
eloping a simple and effective tool for assessing decisionmaking capacity i
n ICU patients.