Health Affairs, 24, no. 6 (2005): 1686-1687 doi: 10.1377/hlthaff.24.6.1686-a © 2005 by Project HOPE	New Online   Obama's Success & Next Steps   3 Health Policy Options for President Obama   A Hybrid Proposal   Bipartisan Compromise

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Letters

What About Proxies?

The principal defect of living wills is their rigid specificity. Living wills tend to deal strictly with what is not wanted in end-of-life care; however, someone who is the patient’s proxy in health care issues can assure control over when a limitless range of interventions are initiated and terminated, regardless of why the patient is incapacitated. Further, living wills reflect patients’ wishes at a particular time and circumstance. The more the patient’s condition has changed since the living will was prepared, the less confident we ought to be that it is a foolproof basis for substituted judgment. More than her ultimate disposition, Terri Schiavo’s husband and parents were arguing over who had the more accurate insight into what she would have wanted.

That matter is better handled by a proxy whom the patient has chosen and with whom the patient has taken the time to discuss his or her wishes and motivations than by the courts or a static document from another time. Health care proxies might not be perfect. There is always uncertainty in any substituted judgment, and we must trust that proxies are men and women of good will and courage. Yet despite possible imperfections, a proxy seems better suited to make decisions in a dynamic environment than the contents of an inflexible document drawn up when the patient was in excellent health.

Bimal P. Chaudhari and Michael A. Grodin

NOTE

1. L.L. Emanuel and E.J. Emanuel, "The Medical Directive: A New Comprehensive Advance Care Document," Journal of the American Medical Association 261, no. 22 (1989): 3288–3293.[Abstract]

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