Abstract

Proxy or surrogate decision making is an issue that arises regularly in hospitals and other healthcare facilities as patients age, become ill, and lose their capacity to make their wishes and choices known. End-of-life (EOL) decision making is stressful for families, who often fill the role of proxy decision makers, particularly if they do not know or do not have documentation of the patient’s wishes. The burden of trying to understand the patient’s condition, diagnosis, and prognosis, the medical jargon, and the treatment options is emotionally and psychologically weighty. Proxies may not have had conversations with the patient about his or her EOL wishes and, therefore, may be left to base choices on their sense of what the patient would have wanted or the proxy’s own values. What seems increasingly common is that physicians are trained to avoid being paternalistic at all costs; instead, they are encouraged to provide a menu of medical options from which the proxy is supposed to choose. In the worst-case scenario, this approach leaves the proxy having to wade through the choices without much guidance and with varying degrees of understanding and a feeling of being overwhelmed. The potential and actual guilt of choosing the ‘‘wrong’’ option is real and evident when dealing with these situations. In the best-case scenario, the physician, healthcare team, and proxy make the decision together in accordance with the patient’s values and known wishes. Too often in modern health care, however, it seems that this is not the case.