How agents operate – Expectations of patients and doctors

We have conducted studies to evaluate the expectations of patients and doctors with regard to the authority of agents (Medical Enduring Power of Attorney; MEPOA).

In an initial study we observed the response of Intensive Care doctors to a ‘grey’ case (where treatment could work but would be likely to be burdensome in a patient with poor function). In this scenario an appointed agent (MEPOA) requested palliation, however 17% of doctors chose to persist with full life support and a further 41% continued with more limited treatment. Only 42% instituted palliative treatment as requested. The potential reversibility of the acute disease was the most frequently cited justification.

A further study was designed to establish how those patients who had appointed an agent (MEPOA) expected them to approach the decision making process. In this study almost all (91%) expected their agent to make the treatment decision by following their prior directive or values but 39% also wanted their agent to follow the treatment recommendation of the treating doctor and 31% to follow the treatment decision of the family. 13% expected the agent to follow the wishes of the doctor, the family and the advance directive at the same time! Where patients wanted the agent to follow various wishes they did not indicate how conflict should be resolved.

Both of the approach of the ICU doctors and the expectations of the patients is inconsistent with the concept that the agent (MEPOA) is granted the autonomous authority to make important treatment decisions.