Data suggests lack of physician awareness of surrogate decision-making laws in Indiana

Oct. 13, 2016

A researcher from the IU School of Health and Rehabilitation Sciences is working to uncover misunderstandings surrounding Indiana's health care surrogate decision-making laws.Amber

With the goal of aiding Indiana lawmakers' efforts to improve antiquated laws, Amber Comer, an assistant professor in the school's Department of Health Sciences, and colleagues from the IU School of Medicine and Richard M. Fairbanks School of Public Health have investigated the effectiveness of the laws, releasing valuable data on physician awareness of surrogate decision-making.

In a recently published study that surveyed more than 400 Indiana physicians, the researchers discovered that only 48 percent of the health care providers fully understood the state laws regarding surrogate decision-making, and 98 percent would willingly disregard the law to allow non-legal surrogates, such as grandchildren, to make critical health care decisions.

"Physicians are being placed in a position where they are forced to decide whether they will follow the law or do what is ethically appropriate," said Comer, lead author of the study. "When physicians follow the law, families are hurt because they must pursue legal action through the courts in order to make health care decisions for their ill loved one. The issues with the health care consent law should be addressed to protect families. Indiana is behind other states, as the majority have already addressed these surrogate decision-making issues in their health care consent laws."

Under current Indiana law, once a person is unable to make their own medical decisions, a legally appointed surrogate is called upon to determine health care choices. This is usually based on representation forms that must be completed before any issues arise. But in many cases, physicians find themselves working with patients who have no legally appointed health care surrogate. It is becoming more common for grandchildren or long-term partners to be caretakers, but under current law, they would not be able to determine care.

While more than 90 percent of the respondents recognized that grandchildren are not legally considered surrogates, these physicians indicated that health care decision-making would be granted to the grandchildren in a clinic setting. In addition, more than 40 percent of the survey's respondents would consult with unmarried same-sex and common-law partners about health care decisions for an incapacitated patient.

Comer and her colleagues theorize that regardless of the laws, these physicians believe that these choices are ethically appropriate.

While it has been acknowledged that Indiana's health care surrogate laws are antiquated, this data shines a light on what is actually happening every day in hospital settings across the state.    

"Families have changed in recent years. For many people, an unmarried partner may be their closest companion. Many older adults rely on in-laws or grandchildren to care for them -- but these relatives currently have no legal standing to make health decisions in Indiana without filling out a legal document such as a health care representative form," said Dr. Alexia Torke, a faculty member at the IU School of Medicine and co-author on the study.

This study was conducted in collaboration with Dr. Margaret Gaffney of the IU School of Medicine and Cynthia Stone of the Fairbanks School of Public Health.