See New York Task Force on Life and the Law, When Others Must Choose Deciding for Patients Without Capacity (New York: New York State Task Force on Life and the Law, 1992); and Emanuel, E.J. and Emanuel, L.L., “Proxy Decision Making for Incompetent Patients: An Ethical and Empirical Analysis,” JAMA, 267 (1992): 2067–71.Google Scholar

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^*We refer to the person for whom substitute health care decisions are made as the “patient” and the substitute decider as the “proxy” or “surrogate,” depending on how the responsibilities are assumed. For purposes of clarity, the patient is referred to as “he” and the proxy or surrogate as “she.”Google Scholar

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Statistical data on the percentage of people with advance directives vary. Studies during the 1990s place the figure at between 15 to 25 percent. See Miles, S.H. Koepp, R., and Weber, E.P., “Advance End-of-Life Treatment Planning: A Research Review,” Archives of Internal Medicine, 156 (1996): 1062–68; Nolan, M.T. and Bruder, M., “Patient Attitudes Toward Advance Directives and End-of-Life Treatment Decisions,” Nursing Outlook, 45 (1997): 204–08; and Sachs, G.A. Stocking, C.D., and Miles, S.H., “Empowerment of the Older Patient? Randomized, Controlled Trial to Increase Discussion and Use of Advance Directives,” Journal of the American Geriatric Society, 40 (1991): 269–73. Some studies indicate that the range falls as low as 4 to 7 percent. See LaPuma, J. Orentlicher, D., and Moss, R., “Advance Directives on Admission: Clinical Implications and Analysis of the Patient Self Determination Act of 1990,” JAMA, 266 (1991): –05; and Emanuel, L.L. et al., “Advance Directives for Medical Care: A Case for Greater Use,” N. Engl. J. Med., 324 (1991): 889–95. One explanation for the variation is disparity by age. It has been reported that approximately 5 percent of adults under forty years of age have advance directives, while an estimated 70 percent of the elderly population has such instruments. See Miles, Koepp, , and Webber, supra.CrossRefGoogle Scholar

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