When Patients and Surrogates Disagree About Advance Directives

In a recent issue of CHEST (February 2016), Bruce et al1 describe decision-making when surrogates disagree with an advance directive and then lay out four considerations for overriding an advance directive. The authors may be comforted to know that there is empiric evidence showing that most patients would welcome having their advance directive ignored. In a study of 300 terminally ill patients who were asked whether they would want their advance directive followed should a loved one object, 54% said they would want their advance directive ignored.2 Reasons given were that surrogates made better decisions, or the patients were concerned that the surrogates' best interest be paramount.

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