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Reconsidering Capacity to Appoint a Healthcare Proxy

Published online by Cambridge University Press:  05 December 2022

Jacob M. Appel
Jacob M. Appel*
Affiliation:
Icahn School of Medicine at Mount Sinai, New York, New York 11029, USA
*
Email: jacobmappel@gmail.com
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Abstract

Clinicians are often called upon to assess the capacity of a patient to appoint a healthcare agent. Although a consensus has emerged that the standard for such assessment should differ from that for capacity to render specific healthcare decisions, exactly what standard should be employed remains unsettled and differs by jurisdiction. The current models in use draw heavily upon analogous methods used in clinical assessment, such as the “four skills” approach. This essay proposes an alternative model that relies upon categorization and sliding scale risk assessment that can be used to determine to how much scrutiny the proxy appointment should be subjected and how much certainty of accuracy should be required in order to maximize the patient’s autonomy and ensure that her underlying wishes are met.

Keywords

proxysurrogatethird-partydecision makingcapacity
Type
Research Article
Information
Cambridge Quarterly of Healthcare Ethics , Volume 32 , Issue 1 , January 2023 , pp. 69 - 75
Copyright
© The Author(s), 2022. Published by Cambridge University Press

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References

Notes

1. Sabatino, CP. The evolution of health care advance planning law and policy. Milbank Quarterly 2010;88(2):211–39CrossRefGoogle ScholarPubMed.

2. Greco, PJ, Schulman, KA, Lavizzo-Mourey, R, Hansen-Flaschen, J. The patient self-determination act and the future of advance directives. Annals of Internal Medicine 1991;115(8):639–43CrossRefGoogle ScholarPubMed.

3. DeMartino, ES, Dudzinski, DM, Doyle, CK, Sperry, BP, Gregory, SE, Siegler, M, et al. Who decides when a patient can’t? Statutes on alternate decision makers. New England Journal of Medicine 2017;376(15):1478–82CrossRefGoogle ScholarPubMed.

4. Schmidhuber, M, Haeupler, S, Marinova-Schmidt, V, Frewer, A, Kolominsky-Rabas, PL. Advance directives as support of autonomy for persons with dementia? A pilot study among persons with dementia and their informal caregivers. Dementia and Geriatric Cognitive Disorders 2017;7(3):328–38CrossRefGoogle ScholarPubMed.

5. Dresser, R. Bound to treatment: The Ulysses contract. Hastings Center Report 1984;14:13–6Google ScholarPubMed.

6. Appel, JM. Trial by triad: Substituted judgment, mental illness and the right to die. Journal of Medical Ethics 2022;48:358–61CrossRefGoogle ScholarPubMed.

7. Davis, JK. Precedent autonomy, advance directives, and end-of-life care. In: Steinbock, B, ed. The Oxford Handbook of Bioethics. Oxford: Oxford University Press; 2007:349–74Google Scholar.

8. Kim, SY, Appelbaum, PS. The capacity to appoint a proxy and the possibility of concurrent proxy directives. Behavioral Sciences & the Law 2006;24(4):469–78CrossRefGoogle ScholarPubMed.

9. Moye, J, Sabatino, CP, Weintraub Brendel, R. Evaluation of the capacity to appoint a healthcare proxy. American Journal of Geriatric Psychiatry 2013;21(4):326–36CrossRefGoogle ScholarPubMed.

10. Navin, M, Wasserman, JA, Stahl, D, Tomlinson, T. The capacity to designate a surrogate is distinct from decisional capacity: Normative and empirical considerations. Journal of Medical Ethics 2022;48:189–92Google ScholarPubMed.

11. See note 9, Moye 2013, at 326–36.

12. See note 9, Moye 2013, at 326–36.

13. See note 9, Moye 2013, at 326–36.

14. Michigan Compiled Laws 700.5506 (1998).

15. California Probate Code, 4120 (1994).

16. MA Gen L Ch 201D (2012).

17. Davis v. Kindred Healthcare Operating, Inc., et al., 2011 WL 1467212 (Tenn. Ct. App. April 19, 2011).

18. See note 10, Navin et al. 2022, at 189–92.

19. Schouten, R, Brendel, RW Guardianships, conservatorships, and alternative forms of substitute decision making. In: Schouten, R, ed. Mental Health Practice and the Law. Oxford: Oxford University Press; 2017:117–52CrossRefGoogle Scholar.

20. Conn. Gen. Stat. Ann. §§ 19a-575 and 19a-577.

21. Liptzin, B, Peisah, C, Shulman, K, Finkel, S. Testamentary capacity and delirium. International Psychogeriatrics 2010;22(6):950–6CrossRefGoogle ScholarPubMed.

22. Frolik, LA, Radford, MF. “Sufficient” capacity: The contrasting capacity requirements for different documents. NAELA Journal 2006;2:303 Google Scholar.

23. Champine, P. Expertise and instinct in the assessment of testamentary capacity. Villanova Law Review 2006;51:25 Google Scholar.

24. Vermont Statutes, Title 18, Chapter 231, 9701 (2018).

25. Utah Code 75-2a-105.

26. Utah Code 75-2a-105.

27. New York Consolidated Laws, Public Health Law—PBH § 2981.

28. See note 8, Kim, Appelbaum 2006, at 469–78.

29. See note 8, Kim, Appelbaum 2006, at 469–78.

30. See note 8, Kim, Appelbaum 2006, at 469–78.

31. Appelbaum, PS, Grisso, T. Assessing patients’ capacities to consent to treatment. New England Journal of Medicine 1988;319(25):1635–8CrossRefGoogle ScholarPubMed.

32. See note 8, Kim, Appelbaum 2006, at 469–78.

33. See note 8, Kim, Appelbaum 2006, at 469–78.

34. See note 19, Schouten, Brendel 2017, at 117–52.

35. See note 9, Moye 2013, at 326–36.

36. See note 10, Navin et al. 2022, at 189–92.

37. See note 19, Schouten, Brendel 2017, at 117–52.

38. Drane, JF. Competency to give an informed consent: A model for making clinical assessments. JAMA 1984;252(7):925–7CrossRefGoogle Scholar.

39. Roth, LH, Meisel, A, Lidz, CW. Tests of competency to consent to treatment. American Journal of Psychiatry 1977;134(3):279–84Google ScholarPubMed.

40. Drane, JF. The many faces of competency. Hastings Center Report 1985;15(2):17–21 Google ScholarPubMed.

41. Buchanan, AE, Brock, DW, Deciding for others: The ethics of surrogate decision-making. New York: Cambridge University Press; 1990 CrossRefGoogle Scholar.

42. NY PHL §§ 2980–2994 (1991).

43. NY PHL Article 29-CC (2010).

44. See note 8, Kim, Appelbaum 2006, at 469–78.

45. MA Gen L Ch 201D § 7 (2012); NY PHL §§ 2980–2994 (1991).

46. Yadav, KN, Gabler, NB, Cooney, E, Kent, S, Kim, J, Herbst, N, et al. Approximately one in three us adults completes any type of advance directive for end-of-life care. Health Affairs 2017;36(7):1244–51CrossRefGoogle ScholarPubMed.

47. The Conversation Project; available at https://theconversationproject.org/wp-content/uploads/2018/06/TCP_OnePager.pdf (last accessed 20 July 2021).