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Proxy consent: moral authority misconceived

Wrigley, Anthony

Authors



Abstract

The Mental Capacity Act 2005 has provided unified scope in the British medical system for proxy consent with regard to medical decisions, in the form of a lasting power of attorney. While the intentions are to increase the autonomous decision making powers of those unable to consent, the author of this paper argues that the whole notion of proxy consent collapses into a paternalistic judgement regarding the other person’s best interests and that the new legislation introduces only an advisor, not a proxy with the moral authority to make treatment decisions on behalf of another. The criticism is threefold. First, there is good empirical evidence that people are poor proxy decision makers as regards accurately representing other people’s desires and wishes, and this is therefore a pragmatically inadequate method of gaining consent. Second, philosophical theory explaining how we represent other people’s thought processes indicates that we are unlikely ever to achieve accurate simulations of others’ wishes in making a proxy decision. Third, even if we could accurately simulate other people’s beliefs and wishes, the current construction of proxy consent in the Mental Capacity Act means that it has no significant ethical authority to match that of autonomous decision making. Instead, it is governed by a professional, paternalistic, best-interests judgement that undermines the intended role of a proxy decision maker. The author argues in favour of clearly adopting the paternalistic best-interests option and viewing the proxy as solely an advisor to the professional medical team in helping make best-interests judgements.

Citation

Wrigley, A. (2007). Proxy consent: moral authority misconceived. Journal of Medical Ethics, 33(9), 527-531. https://doi.org/10.1136/jme.2006.019711

Journal Article Type Article
Acceptance Date Jan 8, 2007
Online Publication Date Aug 30, 2007
Publication Date 2007-09
Deposit Date May 30, 2024
Journal Journal of Medical Ethics
Print ISSN 0306-6800
Electronic ISSN 1473-4257
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 33
Issue 9
Pages 527-531
DOI https://doi.org/10.1136/jme.2006.019711
Public URL https://keele-repository.worktribe.com/output/834570
Publisher URL https://jme.bmj.com/content/33/9/527