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The Doctor-Proxy Relationship: Perception and Communication

Published online by Cambridge University Press:  01 January 2021

Jomarie Zeleznik ,
Linda Farber Post ,
Michael Mulvihill ,
Laurie G. Jacobs ,
William B. Burton  and
Nancy Neveloff Dubler
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Extract

Health care decision making has changed profoundly during the past several decades. Advances in scientific knowledge, technology, and professional skill enable medical providers to extend and enhance life by increasing the ability to cure disease, manage disability, and palliate suffering. Ironically, the same interventions can prolong painful existence and protract the dying process. Recognizing that medical interventions, especially lifesustaining measures, are not always medically appropriate or even desired by a patient or family, health care professionals endeavor to determine who should make health care decisions and according to what standards. The importance that Western culture places on individual rights and self-determination is reflected in the growing advocacy for patient autonomy and the discrediting of physician paternalism. However, the question of autonomy becomes more complex when patients lack the capacity to decide for themselves.

Advance directives represent one response to the dilemma of decision making for incapacitated patients. The original advance directive, the living will, is a written list of instructions reflecting the individual's wishes about care, usually at the end of life.

Type
Article
Information
Journal of Law, Medicine & Ethics , Volume 27 , Issue 1 , Spring 1999 , pp. 13 - 19
Copyright
Copyright © American Society of Law, Medicine and Ethics 1999

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References

See Singer, P.A. Martin, D.K., and Kelner, M., “Quality End-of-Life Care: Patients' Perspectives,” JAMA, 281 (1999): 163–68; Kaufman, S.R., “Intensive Care, Old Age, and the Problem of Death in America,” Gerontologist, 38 (1998): 715–25; Post, L.F. and Dubler, N.N., “Palliative Care: A Bioethical Definition, Principles and Clinical Guidelines,” Bioethics Forum, 13 (1997): 17–24; and Brody, H. et al., “Withdrawing Intensive Life-Sustaining Treatment: Compassionate Clinical Management,” N. Engl. J. Med., 336 (1997): 652–57.CrossRefGoogle Scholar
See Schneiderman, L.F. Teetzel, H., and Kalmanson, A.G., “Who Decides Who Decides? When Disagreement Occurs Between the Physician and the Patient's Appointed Proxy About the Patient's Decision-Making Capacity,” Archives of Internal Medicine, 155 (1995): 793–95; In re Quinlan, 335 A.2d 647 (N.J. 1976); and In re Conroy, 486 A.2d 1209 (N.J. 1985).CrossRefGoogle Scholar
See Redelmeier, D.A. Rozin, P., and Kahnemahn, D., “Understanding Patients' Decisions: Cognitive and Emotional Perspectives,” JAMA, 270 (1993): 72–76; and Miles, S.H. Koepp, R., and Weber, E.P., “Advance End-of-Life Treatment Planning: A Research Review,” Archives of Internal Medicine, 156 (1996): 1062–68.Google Scholar
See Buchanan, A.E. and Brock, D.W., “Deciding for Others: Competency,” Milbank Quarterly, 64 (1986): 67–80.CrossRefGoogle Scholar
See Dubler, N.N., “The Doctor-Proxy Relationship: The Neglected Connection,” Kennedy Institute of Ethics Journal, 5 (1995): 289–306; Emanuel, E.J. et al., “How is the Patient Self-Determination Act Working? An Early Assessment,” American Journal of Medicine, 95 (1993): 619–28; Emanuel, L.L. et al., “Advance Directives: Stability of Patients' Treatment Choices,” Archives of Internal Medicine, 154 (1994): 209–17; Sabatino, C.P., “Surely the Wizard Will Help Us, Toto? Implementing the Patient Self-Determination Act,” Hastings Center Report, 23, no. 1 (1993): 12–16; Kapp, M.B., “Implications of the Patient Self-Determination Act for Psychiatric Practice,” Hospital and Community Psychiatry, 45 (1994): 355–58; and Patient Self-Determination Act, 42 U.S.C.A. § 1395cc(f) (1992).Google Scholar
See Eisendrath, S.J. and Jonsen, A.R., “The Living Will: Help or Hindrance?,” JAMA, 249 (1983): 2054–58.Google Scholar
See Annas, G.J., “The Health Care Proxy and the Living Will,” N. Engl. J. Med., 324 (1991): 1210–13.Google Scholar
See In re Eichner, 438 N.Y.S.2d 266 (1981); and In re Mary O'Connor, 534 N.Y.S.2d 886 (1988).Google Scholar
See Lo, B., “Assessing Decisional Capacity,” Law, Medicine & Health Care, 18 (1990): 193–201; Strull, W.M. Lo, B., and Charles, G., “Do Patients Want to Participate in Medical Decision Making?,” JAMA, 252 (1984): 2990–94; and Emanuel, L., “The Health Care Directive: Learning How to Draft Advance Care Documents,” Journal of the American Geriatric Society, 39 (1991): 1221–28.Google Scholar
See Dubler, supra note 5.Google Scholar
See id.Google Scholar
See Seckler, A.B. et al., “Substituted Judgment: How Accurate Proxy Predictions?,” Annals of Internal Medicine, 115 (1991): 92–98; Diamond, E.L. et al., “Decision-Making Ability and Advance Directive Preferences in Nursing Home Patients and Proxies,” Gerontologist, 29 (1989): 622–26; Zweibel, N.R. and Cassel, C.K., “Treatment Choices at the End of Life: A Comparison of Decisions by Older Patients and Their Physician-Selected Proxies,” Gerontologist, 29 (1989): 615–21; Gerety, M.B. et al., “Medical Treatment Preferences of Nursing Home Residents: Relationship to Function and Concordance with Surrogate Decision-Makers,” Journal of the American Geriatric Society, 41 (1993): 953–60.Google Scholar
See Folstein, M.F. Folstein, S.E., and McHugh, P.R., “Mini-Mental State, A Practical Method for Grading the Cognitive State of Patients for the Clinician,” Journal of Psychiatry Research, 12 (1975): 189–98.CrossRefGoogle Scholar
See Nolan, M.T. and Bruder, M., “Patient Attitudes Toward Advance Directives and End-of-Life Treatment Decisions,” Nursing Outlook, 45, no. 5 (1997): 204–48; Sachs, G.A. Stocking, C.D., and Miles, S.H., “Empowerment of the Older Patient? Randomized, Controlled Trial to Increase Discussion and Use of Advance Directives,” Journal of the American Geriatric Society, 40 (1991): 269–73; LaPuma, J. Orentlicher, D., and Moss, R., “Advance Directives on Admission: Clinical Implications and Analysis of the Patient Self Determination Act of 1990,” JAMA, 266 (1991): 402–25; Emanuel, L.L. et al., “Advance Directives for Medical Care: A Case for Greater Use,” N. Engl. J. Med., 324 (1991): 889–95; and Miles, Koepp, , and Weber, supra note 3.Google Scholar
See 42 U.S.C. § 1395cc(f) (1992).Google Scholar
See Seckler, et al., supra note 12; Diamond, et al., supra note 12; Zweibel, and Cassel, supra note 12; and Gerety, et al., supra note 12.Google Scholar