Many Very Ill Patients Choose 'Next of Kin' Who Aren't, Study Finds

But state laws may trump those choices, possibly leading to care delays

Tuesday, April 7, 2015

Related MedlinePlus Pages

TUESDAY, April 7, 2015 (HealthDay News) -- Nearly one out of 10 veterans in Connecticut younger than 65 have chosen someone who is not part of their immediate family as their next of kin, a new study reports.

Immediate -- or nuclear -- family generally includes a person's spouse, adult child, parent or sibling.

However, state laws won't allow non-immediate family members to make medical decisions on behalf of the patients, unless the patients have specifically named them in a living will or other legal document, said lead author Dr. Andrew Cohen, a postdoctoral fellow at the Yale University School of Medicine in New Haven, Conn.

This could cause delays and confusion over crucial medical care needed to treat a personal health crisis, he said.

"When difficult decisions arise, it can cause delays and adverse consequences if people aren't sure who should be making decisions," Cohen said.

And, under current laws, it's possible that a family member with little to no participation in a person's day-to-day life could end up responsible for making life-and-death medical decisions on that person's behalf, according to the researchers.

The study is published in the April 7 issue of the Journal of the American Medical Association.

State laws known as default surrogate consent statutes set the priority of people who could be called upon to act as a surrogate during a medical emergency that has incapacitated someone, the authors said.

These laws vary from state to state, but generally give members of the immediate family highest priority. The Yale researchers found that little is known about how often patients identify a person who isn't part of their nuclear family as their next of kin.

To explore that question, they reviewed the records of nearly 110,000 veterans. All were receiving care at Veterans Health Administration facilities in Connecticut between 2003 and 2013. Veterans are asked for next-of-kin information, which is entered into their electronic health records along with a description of their relationship with that person.

The investigators found that 7 percent of the time, veterans identified people outside their immediate family as their next of kin.

Younger people were more likely to pick their next of kin from outside their immediate family, the researchers found. About 9 percent of vets younger than 65 went outside their immediate family for an emergency contact, compared with 6 percent of vets 65 and older.

"We think the percentage we found, particularly in people under 65, is high enough that it raises the question whether these statutes should be uniform across states and universally recognize people who aren't nuclear-family members as next of kin," Cohen said.

Vets who chose next of kin from outside the immediate family circle included:

3 percent who selected a more distant relative.
2 percent who selected a friend.
1 percent who selected someone with whom they had a relationship outside marriage, including live-in soul mates and same-sex partners.
Less than 1 percent who indicated an ex-spouse.

These vets reflect the state of today's mobile society, where a person might end up far from where they were raised, said Jonathan Keyserling, senior vice president for health policy and in-house counsel for the National Hospice and Palliative Care Association.

"Traditionally, families stayed in close proximity to one another, and there was a greater expectation that end-of-life care would be provided by a family member," Keyserling said.

The numbers also reflect the way families are changing in America. Veterans under 65 were more than twice as likely to identify their next of kin from a relationship outside of marriage, compared with their older counterparts.

The study authors said that their findings call for a reassessment of state default consent laws, so that a person's identified next of kin will have a say during a medical emergency.

"People under 65 are more likely to have close relationships that aren't nuclear-family relationships," Cohen said. "Given these results, it might be worth thinking about whether these default consent statutes should be more uniform across the nation."

But Keyserling said this issue also highlights the importance of advance planning for medical emergencies, particularly for people who live away from their families.

"Before we get to the notion of state legislatures reviewing their next-of-kin statutes, I think it points to a greater need for ongoing conversations within families and relationship networks, so before a time of crisis a person and their loved ones will have a good idea of what they want and what they don't want," he said. "Everybody ought to have these conversations on an ongoing basis."

SOURCES: Andrew Cohen, M.D., D.Phil., postdoctoral fellow, Yale University School of Medicine, New Haven, Conn.; Jonathan Keyserling, senior vice president for health policy and in-house counsel, National Hospice and Palliative Care Association; April 7, 2015, Journal of the American Medical Association

HealthDay