Projection in surrogate decisions about life-sustaining medical treatments

To honor the wishes of an incapacitated patient, surrogate decision makers must predict the treatment decisions patients would make for themselves if able. Social psychological research, however, suggests that surrogates' own treatment preferences may influence their predictions of others' preferenc es. In 2 studies (1 involving 60 college student surrogates and a parent, t he other involving 361 elderly outpatients and their chosen surrogate decis ion maker), surrogates predicted whether a close other would want life-sust aining treatment in hypothetical end-of-life scenarios and stated their own treatment preferences in the same scenarios. Surrogate predictions more cl osely resembled surrogates' own treatment wishes than they did the wishes o f the individual they were trying to predict. Although the majority of pred iction errors reflected inaccurate use of surrogates' own treatment prefere nces, projection was also found to result in accurate prediction more often than counterprojective predictions. The rationality and accuracy of projec tion in surrogate decision making is discussed.