Predicting a Partner's End‐of‐Life Preferences, or Substituting One's Own?

• DOI: http://doi.org/10.1111/jomf.12030
• Date: 01 June 2013
• Author: Sara M. Moorman,Megumi Inoue
• Published date: 01 June 2013

SARA M. MOORMAN Boston College

MEGUMI INOUE Boston College∗

Predicting a Partner’s End-of-Life Preferences,

or Substituting One’s Own?

Numerous studies comparing patients’ end-

of-life health care treatment preferences with

their surrogates’ reports of those preferences

indicate that partners do not know one another’s

treatment preferences: Random guesses are

just as likely as surrogate choices to match

the patients’ preferences. The present study

uses the empathic accuracy model and the

assumed similarity model to shed further light

on accuracy and bias in surrogate reports.

The data come from the National Center

for Family and Marriage Research/Knowledge

Networks Pilot Study 2010, a national sample

of 1,075 heterosexual American couples age 18

to 64. Surrogate reports were simultaneously

biased (i.e., correlated with the surrogate’s

own preference) and accurate (i.e., correlated

with the partner’s actual preference). Higher

relationship quality and legal marriage (vs.

cohabitation) were associated with increased

assumed similarity bias. These f‌indings suggest

that practitioners working in end-of-life care

need to be familiar with their partnered patients’

relationship dynamics.

Department of Sociology and Institute on Aging, Boston

College, 140 Commonwealth Ave., McGuinn Hall 426,

Chestnut Hill, MA 02467-3807 (moormans@bc.edu).

∗School of Social Work and Institute on Aging, Boston

College, 140 Commonwealth Ave. McGuinn Hall, Chestnut

Hill, MA 02467.

Key Words: dyadic/couple data, families in middle and later

life, health, multilevel models, relationship satisfaction, U.S.

families.

Throughout the life course, romantic partners

monitor one another’s health, providing pressure

to adopt healthy behaviors, encouragement to

adhere to those behaviors, and instrumental

assistance in doing so (Thoits, 2011). Partners

continue affecting one another’s health even

at the end of life, when a partner can be

instrumental in determining the health care a

dying person receives. In 70% of cases in

which a dying older person requires a treatment

decision, the person has lost the capacity to make

decisions for him- or herself (Silveira, Kim, &

Langa, 2010). For 75% of married older adults,

the spouse serves as the legal surrogate who is

authorized to make medical decisions on behalf

of the incapacitated patient (known as a durable

power of attorney for health care [DPAHC];

Carr & Khodyakov, 2007).

The law instructs surrogates to apply the

standard of substituted judgment, that is, to

choose the treatment that the patient him-

or herself would choose if able (Sabatino,

2010). Nevertheless, numerous studies that

have used hypothetical treatment scenarios to

match participants’ preferences to their spousal

surrogates’ reports of those preferences indicate

that spouses may often fail at substituted

judgment: Random guesses are just as likely

as surrogate choices to match participants’

preferences (e.g., Moorman & Carr, 2008;

Shalowitz, Garrett-Meyer, & Wendler, 2006).

Furthermore, although many studies have

investigated factors that may inf‌luence sub-

stituted judgment, few have identif‌ied reliable

correlates. For instance, men and women are

734 Journal of Marriage and Family 75 (June 2013): 734 –745

DOI:10.1111/jomf.12030