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The Limits of Proxy Decision Making: Undertreatment

Published online by Cambridge University Press:  29 July 2009

Muriel R. Gillick  and
Terri Fried
Muriel R. Gillick
Affiliation:
Assistant Professor of Medicine, Harvard Medical School, and Associate Director of the Harvard Geriatric Fellowship Program, Boston
Terri Fried
Affiliation:
Assistant Physician in the Division of Geriatrics, Rhode Island Hospital, and Assistant Professor, Brown University School of Medicine, Providence, Rhode Island
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Extract

With the passage by virtually every state legislature of healthcare proxy laws, the medical profession increasingly can expect to rely on the participation of surrogates in making decisions on behalf of incompetent patients. Several concerns about the legitimacy of proxy decision making have been discussed in the ethical and general medical literature: the lack of concordance between the views of patients and their surrogates have been documented on multiple occasions, and cases of abuse by proxies or potential conflict of interest have been reported. Another dilemma that deserves discussion arises when proxies demand withdrawal of treatment that physicians and nurses regard as essential to the wellbeing of the patient. The following case highlights this dilemma.

Type
Special Section: Elder Ethics
Information
Cambridge Quarterly of Healthcare Ethics , Volume 4 , Issue 2 , Spring 1995 , pp. 172 - 177
Copyright
Copyright © Cambridge University Press 1995

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References

Notes

1. Uhlmann, R, Pearlman, R, Cain, K. Physicians’ and spouses’ predictions of elderly patient’ resuscitation preferences. Journal of Gerontology 1988;43:115–21.CrossRefGoogle Scholar

2. Suhl, J, Simons, P, Reedy, T, Garrick, T. Myth of substituted judgment. Surrogate decision making regarding life support is unreliable. Archives of Internal Medicine 1994;154:90–6.CrossRefGoogle ScholarPubMed

3. Lee, M, Berry, K. Abuse of durable power of attorney for health care: Case report. Journal of the American Geriatric Society 1991;39:806–9.CrossRefGoogle ScholarPubMed

4. Lynn, J. Conflicts of interest in medical decision-making. Journal of the American Geriatric Society 1988;36:945–50.CrossRefGoogle ScholarPubMed

5. Sabatino, C. Surrogate decision-making in health care. Legislative overview. Washington, D.C.: Commission on Legal Problems of the Elderly, American Bar Association, 06 1993.Google Scholar

6. Kapp, M. Geriatrics and the Law. 2nd ed.New York: Springer, 1992.Google Scholar

7. Emanuel, E, Emanuel, L. Proxy decision making for incompetent patients. An ethical and empirical analysis. Journal of the American Medical Association 1992;267:2067–71.CrossRefGoogle ScholarPubMed

8. Annas, G. The health care proxy and the living will. New England Journal of Medicine 1991;324:1210–13.CrossRefGoogle ScholarPubMed

9. Luchins, D, Hanrahan, P. What is appropriate health care for end-stage dementia? Journal of the American Geriatric Society 1993;41:25–30.Google ScholarPubMed

10. In re Claire Conroy. 98 N.J. 321, 1985.

11. Gillick, M. Limiting medical care: Physicians' beliefs, physicians' behavior. Journal of the American Geriatric Society 1988;36:747–52.CrossRefGoogle ScholarPubMed

12. Capron, A. In re Helga Wanglie. Hastings Center Report 1991;Sept-Oct:26–8.Google Scholar

13. Weir, R, Gostin, L. Decisions to abate life-sustaining treatment for nonautonomous patients. Journal of the American Medical Association 1990;264:1846–53.CrossRefGoogle ScholarPubMed