ABSTRACT
Betty Wright had strong preferences about her medical care, fearing progressive debilitation and pain such as her husband suffered. When she becomes incompetent to make medical decisions, her previous statements should guide decisions about her care. Many incompetent patients in New York may receive treatment that they would not want and whose burdens outweigh the benefits. Ascribing refusals to some incompetent patients might also be characterized as a legal fiction. Legal fictions may serve important functions. Most important, relatives are presumed to act in the best interests of the incompetent patient. Ties of kinship and affection generally motivate family members to do what they believe is best for the patient. The doctor can also recommend a plan of care that fits best with the patient's preferences and best interests. Such recommendations are particularly useful when the family of an incompetent patient finds it difficult to take responsibility for decisions about life-sustaining treatment.
