Abstract
Patient autonomy is the cornerstone of our medical ethics. Given this commitment to autonomy, proxy decisions will always strike us as problematic; it is always more difficult to ensure that the wishes of the patient are embodied in treatment decisions when someone else must speak for the patient. And proxy decisions are especially disturbing when we fear that the proxy's judgment is tainted by his own interests, so that the proxy is covertly requesting the treatment he wants the patient to have, rather than the treatment the patient would have wanted. This problem of interested proxies is exacerbated by the fact that we seek out proxies who often turn out to have strong interests in the treatment of the patient. We do this for two reasons: first, those who care deeply for the patient are more likely than others to really want the best for the patient; and second, those who are close to the patient are generally most knowledgeable about what the patient would have wanted. This familiarity allows us to apply the "substituted judgment" standard of proxy decision and, given a commitment to autonomy, substituted judgment is an ethically better basis for proxy decision making than the "reasonable person" or "best interest" standard.
Recommended Citation
Hardwig, John
(1992)
"The Problem of Proxies with Interests
of Their Own: Toward a Better Theory
of Proxy Decisions,"
Utah Law Review: Vol. 1992:
No.
3, Article 4.
Available at:
https://dc.law.utah.edu/ulr/vol1992/iss3/4