« Don't Look Away | Main | Charming »

August 24, 2006

Proxies

I have no particularly incisive thoughts on this, but it's interesting. A new study found that patients selecting their medical proxy (the person who'll make their treatment decisions if they become incapacitated) tend to make unexpected choices. To wit:

• 28% of participants selected someone other than their emergency contacts;

• One-third of married participants did not select their spouses;

• Participants selected their daughters three times more often than their sons and their sisters two times more often than their brothers; and

• About one-fourth of participants said that physicians had never previously asked them to select a proxy.

Hear that, sons? Your parents think you're a bunch of cold-blooded killers.

August 24, 2006 | Permalink

Comments

I got a chuckle out of this - thanks. And it actuallly fits with my own choices. I think you could add "relatively" to the cold-blooded killers part.

Posted by: Judy | Aug 24, 2006 2:45:18 PM

Why does it follow that selecting daughters instead of sons means that patients are afraid that males are more likely to pull the plug?- at least IME, people tend to choose the person that they think are more capable of making that kind of decision, instead of the ones who may be more squeamish. And it's entirely possible that women are considered more able to put themselves in the patient's position and decide to let go instead of allowing the ever-increasing pain & indignities of an inevitable decline.

I don't really have a good candidate for a medical proxy, myself-- normally I trust my sister wrt similar affairs, but while she could probably make the decisions I would were she forced into that position, I also know how it would affect her long-term, and I wouldn't want to be responsible for her misery either, even if I'm no longer around to witness it. It's a tough call.

Posted by: latts | Aug 24, 2006 2:45:56 PM

Your interpretation is backward. People who bother to make a medical proxy almost always do so in conjunction with a living will which specifies that heroic measures should be refused, not undertaken. After all, the default in all US jurisdictions is heroic measures are taken unless otherwise specified (insurance and hospital administrations willing). So people who want everything done to save their lives don't need a proxy.

Thus, one logical conclusion is that parents think their sons are sentimental wusses who wouldn't have the guts to pull the plug. Alternatively, it is another form of gender bias. They don't want to put such a heavy burden on thier sons, but they are happy to have their daughters live with the guilt.

Posted by: anon | Aug 24, 2006 2:59:41 PM

My choice was to make clear that I didn't want extrodinary measures, but to give the ultimate decision to the person who would be most sensitive to people's needs before letting me go.

A daughter is more likely, IMHO, to think about that special aunt who might like to see you one last time before they pull the plug, etc.

Posted by: Chuck | Aug 24, 2006 5:53:40 PM

My mother specifically chose me to be in charge of "pulling the plug" because she was sure I (her daughter) would do it when the time was right. My brother would be too emotional to look at the situation rationally. The results of the survey or sort of useless unless the question of "do you want the plug pulled?" is asked.

Posted by: Mouse | Aug 24, 2006 9:21:47 PM

I'm with the other posters on this. In addition I'm not surprised that people put in someone other than their "emergency contact" to make these decisions. My "emergency contact" could vary from my husband to my brother and his wife depending on which forms I'm filling out--long term or short term, whose in the country, is the emergency contact someone whose going to be called to take me home in a taxi or piick up my kids? Long term and serious issues like who gets to pull the plug devolves on the persons closest to me with the greatest stamina and the least liklihood of feeling intense guilt about the decision. I'm pretty sure that my parents have designated me (the daughgter) and their daughter in law (my brother's wife) because they think I can handle the grief and the responsibility. I can't remember if I designated my husband as my ultimate proxy or if I decided I wanted to spare him the grief and passed the duty on to my brother figuring that it would make it easier for my husband to marry again if he didn't feel that he had had to make that decision for me. whatever the ultimate decision in any given case its probably very influenced by the particular person's own family history of death, disaster, and sibling responsibility. Talk about fighting the last war! people are looking ahead to a hypothetical crisis while looking back at their own family history and figuring out who is playing which role and with what outcome.

aimai

Posted by: aimai | Aug 24, 2006 10:10:28 PM

I'm with the other posters on this. In addition I'm not surprised that people put in someone other than their "emergency contact" to make these decisions. My "emergency contact" could vary from my husband to my brother and his wife depending on which forms I'm filling out--long term or short term, whose in the country, is the emergency contact someone whose going to be called to take me home in a taxi or piick up my kids? Long term and serious issues like who gets to pull the plug devolves on the persons closest to me with the greatest stamina and the least liklihood of feeling intense guilt about the decision. I'm pretty sure that my parents have designated me (the daughgter) and their daughter in law (my brother's wife) because they think I can handle the grief and the responsibility. I can't remember if I designated my husband as my ultimate proxy or if I decided I wanted to spare him the grief and passed the duty on to my brother figuring that it would make it easier for my husband to marry again if he didn't feel that he had had to make that decision for me. whatever the ultimate decision in any given case its probably very influenced by the particular person's own family history of death, disaster, and sibling responsibility. Talk about fighting the last war! people are looking ahead to a hypothetical crisis while looking back at their own family history and figuring out who is playing which role and with what outcome.

aimai

Posted by: aimai | Aug 24, 2006 10:10:45 PM

just want to say - I am living this now as I am terminal. - I picked the person who would follow my wishes to let me go when it is time.

Posted by: Nayd | Aug 25, 2006 1:18:20 AM

Well, I had a heart attack and needed an angioplasty. My big sister told them to pull the plug. It freaked my doctor out. He got on the phone and found another relative to sign the permission slip.
When I recovered, I married my girlfriend. At least she loves me more than insurance money.

Posted by: merlallen | Aug 25, 2006 7:40:36 AM

My mother chose my sister over me (I'm the son) because they have discussed the issues involved more clearly and in greater detail, and because my mother's wish is to have no heroic (or even painful or prolonging) measures taken, and she and I have talked enough to understand that we don't see these things exactly the same way. So she's more comfortable having my sister make the decision.

Posted by: anon2 | Aug 25, 2006 9:01:26 AM

My Dad picked me, #2 son, and I think it was because I'm such a procrastinator.

Posted by: PBen | Aug 25, 2006 10:32:53 AM

• 28% of participants selected someone other than their emergency contacts;
• One-third of married participants did not select their spouses;

I don't know, other people have been picking at the gender thing, and the first two points don't look too surprising to me either: In addition to all the traits you want in a medical proxy, in an emergency contact I want reachability. If for some weird reason I move from Vermont to Washington state, my medical proxy would remain my parents, but I would name my aunt who lives out there my emergency contact. I'm not in that situation right now, but I don't find it hard to believe that 28 percent of prudent adults are.

Posted by: Cyrus | Aug 25, 2006 10:37:29 AM

I watched my husband's family torture their father with surgeries, amputations, and extended hospital stays despite his wishes, because none of them had the guts to say the truth, that he was dying and nothing could be done to cure him. They could have made him comfortable, but no, in our culture, we "fight" death as if it were something that can be beaten.

That's the crux of it. Some cleopatras refuse to believe that modern medical science cannot prevent death. I suspect that lots of people know who the cleopatras are in their families. My husband does not get to make my final decisions. As soon as my daughter turns 18, it's going to be her choice.

Posted by: merciless | Aug 25, 2006 12:42:16 PM

I can see the 1/3 number with regard to people picking people other than their own spouses making sense in light of the fact that about half of all marriages end in divorce anyway. But I have a hard time understanding someone in a good marriage who has a mentally competent spouse selecting someone other than their spouse to be the ultimate decision-maker in these cases. There is no one in the world whose worldview and interests are more aligned with my own than my wife, and vice versa.

As for the daughter thing, the old cliche that a "son is a son until he takes a wife but a daughter is a daughter all her life" comes to mind. It does seem, in my highly unscientific sampling, that sons are much more likely to fall out of touch, become uninterested in family affairs, or turn into outright shits than daughters, but opinions on that are going to vary, obviously. I have two brothers and one sister, and if my mom and dad asked me to recommend who they should designate, I'd pick my sister. I love my brothers, but I wouldn't trust them with my dog's life, let alone my own.

Posted by: Jeff in Texas | Aug 25, 2006 1:13:57 PM

But I have a hard time understanding someone in a good marriage who has a mentally competent spouse selecting someone other than their spouse to be the ultimate decision-maker in these cases.

Well, as far as I know the spouse is the default decision-maker, hence at least one reason for both gay-marriage advocacy and the travesty that was the Terry Schiavo case. But as I noted in an aside upthread, even having a trusted, competent person available still leaves some questions wrt end-of-life issues, because most of us don't want to compound the their [presumed] trauma from losing us with having been literally responsible for the death itself. Ideally, we would all have such emotionally stable, secure partners or relatives that the decisions could be made with a clear conscience, but it's too heavy a burden for some of us to bear.

Didn't mention this before-- my boss (female) is the medical proxy for her mother, who has been in declining health all summer, even though her father is alive & in good health. Her mom didn't think he would be able to make good decisions because he's not in the habit of wrestling with such big issues.

Posted by: latts | Aug 25, 2006 2:11:25 PM

I think in regards to the son/daughter discrepency, that parents pick the child most involved in their day to day care, and caregivers are more often female. It's true in my own mother's case--she has designated another sister. However, my oldest sister has probably not chosen anybody (her son is way more competent to discuss things with doctors than her daughter, and would make good decisions. If she's smart, she'll designate him, but my sis is also bull-headed, and has butted heads with her smart son, so I bet she hasn't picked him.)

Posted by: ciocia | Aug 26, 2006 9:47:55 PM

The comments to this entry are closed.