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Researchers report some patients choose next-of-kin outside of nuclear family

Despite state laws that appoint the next immediate family member as next-of-kin for patients who lose capacity, researchers report a considerable number of veterans from their study chose someone outside their nuclear family as their appointed surrogate decision maker.

“Although a growing number of adults are unmarried and live alone, state default surrogate consent statutes vary in their recognition of important relationships beyond the nuclear family, like friends, more distant relatives and intimate relationships outside of marriage,” Andrew B. Cohen, MD, DPhil, of the section of geriatrics in the department of medicine at Yale School of Medicine, and colleagues, wrote in a research letter published in JAMA.

Cohen and colleagues reviewed data on next-of-kin from records of 109,803 patients treated at Connecticut’s Veterans Health Administration facilities from 2003 to 2013. Most patients were white (87.0%), 53.9% were married and 93.3% were men. The mean age was 68 years.

Results demonstrated that a majority of patients chose someone within their nuclear family as next-of-kin (92.9%; 95% CI, 92.7 – 93.0).

A person outside the nuclear family was chosen as next-of-kin among 7,761 participants (7.1%; 95% CI, 7.0 – 7.2). A distant relative was chosen by 3,190 patients (2.9%; 95% CI, 2.8 – 3.0), and 4,571 patients chose someone who was not legally or biologically related (4.2%; 95% CI, 4.1 – 4.3). Often, the next-of-kin identified as a non-relative was a friend or intimate partner such as a ‘common law spouse,’ ‘live-in soul mate’ or ‘same-sex partner.’ A small number of patients (n = 849) identified their next-of-kin as someone from a social tie (0.8%; 95% CI, 0.7 – 0.8), such as ‘landlady,’ ‘priest,’ ‘roommate’ or ‘sponsor.’

Next-of-kin outside the nuclear family was more often chosen by patients under the age of 65 years, compared with those over age 65 years (P < .001).

“A substantial number of veterans in our sample had a next-of-kin outside the nuclear family. If this finding is confirmed in other populations, states should consider adopting uniform default consent statuses, and these statutes should be broad and inclusive, to reflect the evolving social ties in American life,” Cohen and colleagues wrote. – by Casey Hower

Disclosure: The researchers report no relevant financial disclosures.