Surrogate Decision Making for the Facebook Generation

Four days ago Mr. M develops a sudden severe headache, and chest pain which was not relieved with nitroglycerine. An ambulance brings him to the ER, where he presents in a comatose state. Mr. M's wife has been asked to make decisions about his care. As is the case with the vast majority of patients, Mr. M has left no advance directive or living will. Mrs. M, however, points out that he has discussed his medical situation in great detail on his Facebook page and included statements about his wishes for future care. In addition, his sister has a record of his Tweats in response to the Arizona shootings and his thoughts about whether he would want care if he were seriously disabled.

With all the attention focused on electronic health records (EHRs) and cybermedical practice, there has been little thought given to the role of social media in patient decision making. Those in the so-called “Facebook Generation” have integrated the use of social media into all aspects of their life, and often treat their online identities as an extension of their real-world selves. Many will have been using various sites for many years and may have left significant electronic documentation of their preferences. As the most recent generation of social media users age, questions of how and whether to use social media to assist surrogate decision making will become more prevalent. This presentation considers the ethical and legal issues involved in the use of social media for surrogate decisions.