ABSTRACT
It is especially important to have several sessions with the terminally ill individual and the person he or she has designated to act as medical proxy. Assigning a medical proxy allows the dying person to take care of loved ones while ensuring that wishes will be carried out if he or she becomes unconscious or unable to speak or make decisions on his or her behalf. There is enormous stress inherent in having the responsibility of making life and death decisions for another individual. Not everyone who is very close to a dying person wil l feel able to act as the medical proxy; it is therefore urgent that the specifics of the dying individual's wishes in terms of life support and end-of-life care issues be explicitly discussed with the designated medical proxy. The worker needs to ask the medical proxy whether he or she feels able to carry out orders to discontinue treatments or life support, even if this decision is contrary to the individual's personal wishes and beliefs. The proxy needs to be encouraged to voice all doubts, fears, and concerns, especially those involving authorizing the medical team to "pull the plug." If the proxy is unsure of his or her ability to have treatments or life support terminated, and this is the expressed wish of the ill person, then the proxy should be encouraged to withdraw from this important position. The proxy who is honest about being unable to comply with the ill person's wishes should be supported for helping ensure that the sick person can then proceed to locate an individual who wil l be willing and confident in the ability to shoulder these responsibilities. Once a proxy has expressed willingness to function in this role, then a few more joint sessions are helpful. The patient can express explicit wishes to the proxy and the proxy then repeats the decisions, and the instructions are written down so there is no ambiguity about these crucial matters. It is also useful for these two people to share their feelings about the need for a medical proxy and to express the aspects of their relationship that allow it to include this level of intimacy and trust.
