Surrogate decision‐making around life-sustaining treatments in the hospital even in the best of circumstances is hard.   It’s maybe even harder when caring for those who are conserved or have a professional guardian.  The conservator may not have known the patient prior to them losing capacity, they may not know their values or goals that can help guide decisions, and they may be restricted by state statutes on what decisions they can make without getting a judge's approval.  

The prevailing wisdom is all of the barriers to decision making while under guardianship likely leads to delays in decision making or one that errs on choosing high‐intensity treatment even if it is unlikely to benefit the patient.  But is that really the case?   

On today's podcast, we talk with Andy Cohn, lead author of a recent Journal of the American Geriatrics Society (JAGS) paper titled “Guardianship and End‐of‐Life Care for Veterans with Dementia in Nursing Homes” and Liz Dzeng, the lead author of the accompanying editorial to the paper.   

The big surprise finding of this study was veterans who were nursing home residents aged 65 and older with moderate to severe dementia and who had a professional guardian were no more likely to receive high‐intensity treatments than the same population who died with decision makers who were not professional guardians.   We talk to Andy about his study, potential reasons behind the study, and what, if anything, we should do differently knowing these results.   We also talk to Liz about whether substituted judgement is really all that it’s cracked up to be.

So take a listen and also check out these articles to read more about it:

• Guardianship and End‐of‐Life Care for Veterans with Dementia in Nursing Homes. 
• We Need a Paradigm Shift Around End‐of‐Life Decision Making.
• Guardianship and End-of-Life Decision Making