Problems with Proxy Decision making
These should not be viewed as purely legal documents because they are open to interpretation, and when people give too little or too much detail in their advance directives, there may well be interpretation problems because physicians and family members disagree on the meaning.
The forms provided to outline one’s preferences in end of life care may determine what care options a person is able to consider and what options are made available. These forms can often be too limited in their scope and may not provide the space or opportunity to outline all of the situations one can anticipate and what one’s preferences may be.
Most people do not update their advance directives, and family members may feel that a dated advance directive does not reflect the patient's current thinking. Sometimes medical staff may be unaware that an advance directive exists, which also makes them less effective. 57
There is a tension between Proxy and Instructional directives. Proxy directives may provide more flexibility in response to changing circumstances while instructional emphasize the individual's right to autonomy, privacy and choice without reference to substitute decision makers.58
There are positive and negative treatment decisions to be made at the end of life. One can either request to have treatments terminated (negative decisions) or continued (positive decisions) but there is no legal obligation for physicians to continue treatment they consider to be futile. The power to make decisions about what treatment you want at the end of your life is also limited by the fact that people who are dieing do not have the time or resources to appeal decisions made by their doctor to withdraw ‘treatments.’
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