Emotion by Proxy

In medical ethics the issue of autonomy prompts interesting challenges, such as how to ensure a patient’s wishes are respected once he is unable to speak for himself. “Emotion by Proxy” confronts several tensions related to the choice of a health care power of attorney: incapacity and the persistence of personal identity; living wills versus surrogate decision-makers; medical paternalism overriding emotionally-involved family members; and the ways emotions can affect decisions made on behalf of others. Through a careful study of the goals and implications of patient autonomy, the author defends the appointment of a benevolent 'partner proxy' as best positioned to understand a patient’s life-long values and anticipate the decisions he might have made. Autonomy is maximized when the competent patient appoints a proxy with discretionary authority to make decisions in real time and in a manner that respects the general spirit of the patient’s expressed values. An appropriately-chosen proxy is more useful than overly-specific, binding directives that cannot accommodate technological advancement, prognostic considerations, and personal interests as the patient experiences them.