In this issue of THE JOURNAL, Emanuel and Emanuel1 present an array of concerns about the justifications for, and the effectiveness of, proxy decision making for incompetent adults. Although well founded, these concerns should not dictate any diminution of the current enthusiasm for proxy (or "surrogate") decision making. A morally justifiable and pragmatic policy for decision making for incompetent adults, at this point, will have to rely heavily on appointed and family proxies.
See also p 2067.
Each of us faces a high likelihood of being incapable of managing our own affairs sometime before we die. Decisions that arise at such a time still must be made, and the alternative strategies are few: (1) by proxies (including family and courts, with or without guidance from the patient in advance), (2) in advance by the patient, or (3) by community and professional guidelines. Each of these offers some likely advantages
Lynn J. Procedures for Making Medical Decisions for Incompetent Adults. JAMA. 1992;267(15):2082-2084. doi:10.1001/jama.1992.03480150088044