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

From: Grounds for surrogate decision-making in Japanese clinical practice: a qualitative survey

Core category Category Subcategory
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