If a patient lacks the capacity to make decisions, a proxy decision-maker
should be consulted.
If a patient cannot grant valid informed consent, then, unless their life is in imminent risk, health care providers must get consent from someone who can speak on the behalf of the patient--a surrogate decision-maker--sometimes called proxy decision-maker
This is not so much an issue of authority as of having a family member or proxy decision-maker
in the loop with a "big picture" perspective.
While naming a proxy decision-maker
in an advance directive may help avoid the trauma of court battles, it may not, by itself, get us any closer to the goal of extending patient autonomy into the time when the patient is no longer capable of exercising self- determination on her own behalf.
If you become imcompetent or unable to communicate and have not previously stated your wishes or designated a proxy decision-maker, your next-of-kin may have to make these decisions.
An advance directive that is deficient under the state law and VA criteria still may be used by a proxy decision-maker as evidence of the patient's wishes.
The fact that the family previously chose not to serve as the patient's proxy decision-makers
in this case is important because it may illustrate a particular family dynamic to which the treatment team is not privy.
By encouraging patient use of advance directives, such as Living Wills and designation of proxy decision-makers for health care, Wetle says that the Act "allows the extension of patient autonomy into the period in which patients can no longer communicate for themselves.
Only 30 percent of the social workers, for example, were familiar with the requirement that all residents must be contacted to discuss advanced directives and proxy decision-makers.
The desperate intensity of this search is revealed by the state laws, noted above, that denominate proxy decision-makers
even where an incompetent patient has made no prior selection.