Table 3 Results of the qualitative analysis of the judgment grounds for surrogate decision-making in Japan

1. Patient preference-oriented factor

I respected the patient's preferences

I told them that I had been instructed by the patient to decide against life support

Since the patient’s preferences were clear, my decisions never wavered

I made the decision respecting the patient’s intention regarding life-prolonging treatment

I respected the patient's presumed intentions

I made the decision based on my understanding of what the patient would do

My daily communication helped (patient-family)

I thought the family would be able to guess the patient’s intentions

I think I made the decision believing it to be in line with the patient’s intentions

I guessed the patient’s intentions by observing his/her condition

2. Patient interest-oriented factor

I tried making the decision by considering the patient’s best interests

I valued the patient's safety

I thought it would be good for the patient to receive medical treatment and recover

I did not know what was good for the patient

I did not want to do anything cruel to the patient

I decided against life-prolonging treatment out of pity

The patient appeared to be suffering; so, I thought he or she would be better off with gastrostomy

I made the decision based on the patient’s ADL and communication capacity

I agreed to forego life-prolonging treatment because I sympathized with the patient when I saw him/her being bedridden

I did not choose gastrostomy since the patient was unable to communicate

I thought the patient would find it painful to live in a vegetative state

I thought it was my ego that wanted to choose life-prolonging treatment when the patient's condition was such that no communication was possible

I expected the patient to recover

If the patient had a chance at recovery, I wanted him/her to be treated

I continued to hope for the patient's recovery

I chose artificial alimentation in hopes of recovery

3. Family preference-oriented factor

I wanted to protect my family’s life and interests

I wanted to bring him/her home; so, I chose the procedure (gastrectomy)

I judged it realistically impossible to provide home care

I made the decision that family members would not regret

I realistically considered the lives of family members and decided to forego gastrostomy

I thought that the patient's safety would ensure my own self-protection since I was the surrogate decision-maker

I made the decision based on the thoughts of family members and other people close to the patient

I ignored the discussions that we had in advance

The feelings of the patient's closest family members were important

I wanted the patient to live

I was aware of the stance of the patient who refused life support; but I wanted him/her to live

When death suddenly became a real possibility, I, as a family member, wanted to prolong the patient’s life

I wanted to do everything I could

I had the patient undergo gastrostomy for my family

I thought nobody would want to die

Because the patient's life was limited, I wanted to keep him/her alive for one more day

I accepted death

I had no regrets; so, I didn’t choose life support

I thought that death was inevitable

4. Balanced patient/family preference-oriented factor

I balanced the patient's intentions and lives of family members

I made the decision considering the balance between the patient's life and the lives of family members

I balanced the intention of the patient and the thoughts of family members