ABSTRACT
Using currendy available data we will try to quantify how well instructional directives and proxy decision-
making realize the ideal of patient autonomy. We will then consider alternative policies for decisionmaking for incompetent patients who have no advance directives. We will propose that life-sustaining treatment decisions for these patients be made according to default guidelines that follow the preferences of the local community of patients. These default decisions can: ( 1 ) realize the ideal of patient autonomy for this group of people better than other alternatives; (2) simultaneously honor some of the interests of patients' families; and (3) realize other important values.
