The Proxy Predicament: Making Medical Decisions for Others is Hard

Most of us will lose our ability to make medical decisions for ourselves as we get closer to the last phase of life. At this point, our proxy decision makers will have to make decisions for is. It is impossible for us to truly know what another person may want for themselves in terms of medical decisions. Most proxy decision makers are usually stressed to the maximum in trying to weigh the pros and cons and make decisions for the patient. This process is so much easier if every adult takes 10 minutes to complete the Letter Project form and answer a few simple questions that will clarify what they truly want for themselves. In fact, this will prevent us from burdening our family members with the stressful process of guessing what we may want and what our values and preferences for care are.

Here is what you need to do:

1. Go online to and use the online form (available in many languages) to clarify what matters most to you


2. Go to the Apple Appstore (…) or Google Playstore (…) and download the free Stanford Letter Project App.

Invest ten minutes time in writing your letter. Do not stress your loved ones later; write your letter now so everyone knows what you want. It is free, easy and extremely important.

To read more please check out recent article Pitfalls for Proxies published by the New York Times.

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  • Charlie Antoni

    Charllie Antoni

    Thank you Dr. Periyakoil for this insightful and timely article given the changes in Medicare funding for advance care planning. Many of the barrier’s that you identified are common place for those of us in clinical practice as well as those of us dealing with advance care planning for ourselves and family members.
    I would like to share a comment that I have received after my Advance Directive group ..”.you make it seem so normal”. and I believe that is a key to successful completion and utilization of advance care planning. When it can be offered as “a part of adult life planning …beginning when you are considered an adult in your area of residency. When we encourage shared decision making throughout our life spans/health care continuum. e.g. Participatory Medicine ..participation in our health care discussions and decisions with our partners, children, family, providers will be common, encouraged and accepted. In addition we need to add the bridge to actualizing these documents in real time as in documents like the Physician Orders for Life Sustaining Treatment (POLST) and its derivatives (MOLST) and others. Access to tools like Stanford Successful Aging and End of life’s letter writing initiative or the Institute for Health Care Improvements Conversation Starter Kit needs to be increased making preparation and discussion of our mortality and frailty a natural part of life.

    • Hi Charlie – I like your phrase “you make it seem so normal”. A perspective I aspire to integrate as I start in this journey. Thanks !