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April 15, 1992

Proxy Decision Making for Incompetent PatientsAn Ethical and Empirical Analysis

Author Affiliations

From the Division of Cancer Epidemiology and Control, Dana-Farber Cancer Institute (Dr E. J. Emanuel) and the Division of Medical Ethics, Harvard Medical School (Dr L. L. Emanuel), Boston, Mass. Dr L. L. Emanuel is also a teaching and research scholar of the American College of Physicians.

JAMA. 1992;267(15):2067-2071. doi:10.1001/jama.1992.03480150073040

RECENTLY, proxy or surrogate decision making regarding the termination of life-sustaining interventions for incompetent patients has been widely endorsed and promoted. After the Cruzan decision and the Patient Self-Determination Act of 1990, many states enacted proxy statutes specifically for health care. Indeed, even states such as New York and Massachusetts, which in the past had avoided enacting any legislation on living wills and securing the rights of patients, have quickly adopted

See also pp 2082 and 2101. health care proxy laws. Simultaneously with this growing enthusiasm for proxy decision making have arisen ethical and empirical doubts about whether proxies can select interventions that the patient would have selected. These divergent trends confront us just as there is a growing need to develop policies on this issue. Consequently, it is important to examine several questions on proxy decision making: How widely endorsed is proxy decision making? What is the justification of