However, Mitchell and Lawson cite studies that do not support these claims. Advance directives or living wills would certainly be of help to substitute decision-makers, but the limitations of living wills should be recognized. Singer 3 recommends giving specific directives about health care and personal matters. In addition, he advises that a person appoint a trusted friend or family member to act as proxy or substitute decision-maker. Several provinces already make legal provision for such a person to be recognized, and others are likely to follow suit.
Singer appropriately highlights the importance of frank discussion with a person appointed as proxy.
Without knowledgeable discussions it is difficult to conceive of substitute decision-makers having any confidence that the decisions they make consistent with the wishes of their dependents. Even if a person has carefully followed Singer's instructions related to possible treatment decisions, the proxy may be faced with a complex situation that does not readily fit the template. A comparative study might be revealing on a number of counts. Mitchell and Lawson cite 3 studies in which the patients' advance directives were not considered and 1 in which the substitute decision-makers' perceptions of the patients' wishes were at odds. The patients in their study were described as being incapable of medical decision-making at the time of tube placement, but they do not mention how this was determined or documented.