Hallie, P., “An Apology to My Mother,” in Hallie, P., Tales of Good and Evil, Help and Harm (New York: HarperCollins, 1997): at 85.Google Scholar

By proxy, I mean a surrogate specifically designated by the patient for health care decisions while the patient had decision-making capacity. In some jurisdictions, this individual may be known as a durable power of attorney for health care or as a health care agent.Google Scholar

Introducing the notion of covenant into a discussion concerning the relationships that emerge through the use of advance directives is not without some weighty precedents in other areas of medicine. See Landis, D.A., “Physician Distinguish Thyself: Conflict and Covenant in a Physician's Moral Development,” Perspectives in Biology & Medicine, 36 (1993): 628–41; Crawshaw, R. et al., “Patient-Physician Covenant,” JAMA, 273 (1995): 1553; and Cassel, C.K., “The Patient-Physician Covenant: An Affirmation of Asklepios,” Annals of Internal Medicine, 124 (1996): 604–06.Google Scholar

See, for example, President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, Deciding to Forgo Life-Sustaining Therapy (Washington D.C.: U.S. Government Printing Office, 1983); Buchanan, A.E. and Brock, D.W., Deciding for Others: The Ethics of Surrogate Decision Making (New York: Cambridge University Press, 1990): at 15–211; New York State 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): at 47–69; and Sachs, G.A. and Siegler, M., “Guidelines for Decision Making When the Patient is Incompetent,” Journal of Critical Care Illness, 6 (1991): 348–59.Google Scholar

See Wolf, S.M. et al., “Sources of Concern about the Patient Self-Determination Act,” N. Engl. J. Med., 325 (1991): 1666–71.CrossRefGoogle Scholar

See Fins, J.J. Bacchetta, M.D., and Miller, F.G., “Clinical Pragmatism: A Method of Moral Problem Solving,” Kennedy Institute of Ethics Journal, 7 (1997): 129–45; and Fins, J.J. Miller, F.G., and Bacchetta, M.D., “Clinical Pragmatism: Bridging Theory and Practice,” Kennedy Institute of Ethics Journal, 8 (1998): 39–44.Google Scholar

The New Shorter Oxford English Dictionary (Oxford: Clarendon Press, 1993): at 496, 534.Google Scholar

Hallie, P., “Afterward,” in Hallie, supra note 1, at 209–18.Google Scholar

Hallie, P., Lest Innocent Blood be Shed (New York: Harper & Row, 1979); and Fins, J.J., “From Indifference to Goodness,” Journal of Religion and Health, 35 (1996): 245–54.Google Scholar

May, W.F., Testing the Medical Covenant (Grand Rapids: W.B. Eerdmans, 1996).Google Scholar

May, W.F., “Code and Covenant or Philanthropy and Contract?,” in Lammers, S.E. and Verhey, A., eds., On Moral Medicine: Theological Perspectives in Medical Ethics (Grand Rapids: W.B. Eerdmans, 1987): at 93.Google Scholar

May, W.F., The Physician's Covenant: Images of the Healer in Medical Ethics (Philadelphia: Westminster Press, 1983): at 106–44.Google Scholar

Elwell, W.A., ed., Baker Encyclopedia of the Bible (Grand Rapids: Baker Book House, Vol. 1, 1998): at 530–38.Google Scholar

Elwell, supra note 13, at 531.Google Scholar

Knox, T.M., ed., Hegel's Philosophy of Right (New York: Oxford University Press, 1967): First Part: Abstract Right, (ii) Contract, ¶ (75), at p. 58, and Third Part: Ethical Life, (I) The Family, (a) marriage, ¶ (163), at p. 112.Google Scholar

A more recent commentator has suggested how a marriage contract can become covenantal when sanctified by a shared faith: “Without religion, the institution of marriage—the foundation of family life—is no longer the product of vows made solemnly before God; it is just another contract, less binding, even than a mortgage obligation.” Beran, M.K., The Last Patrician: Bobby Kennedy and the End of American Aristocracy (New York: St. Martin's Press, 1998): at 182.Google Scholar

Having observed that some contractual relationships can evolve into covenantal, it should also be noted that some covenants do not have their origins in contracts.Google Scholar

I am indebted to Nancy Dubler for this phrase.Google Scholar

Dubler, N. and Nimmons, D., Ethics on Call (New York: Harmony Books, 1992): at 341–65.Google Scholar

Fins, J.J., “The Patient Self-Determination Act and Patient-Physician Collaboration in New York State,” New York State Journal of Medicine, 92 (1992): 489–93.Google Scholar

New York State Task Force, supra note 4, at 21–45.Google Scholar

A covenantal approach can assist a proxy because it can help him “serve and draw upon the deeper reserves of the other.” See May, supra note 12, at 121.Google Scholar

Id. at 119.Google Scholar

High, D.M., “Families' Roles in Advance Directives,” Hastings Center Report, 24, no. 6 (1994): S16–S18.CrossRefGoogle Scholar

Singer, P.A. et al., “Reconceptualizing Advance Care Planning from the Patient's Perspective,” Archives of Internal Medicine, 158 (1997): 879–84.CrossRefGoogle Scholar

The SUPPORT Investigators, “A Controlled Trial to Improve Care for Seriously Ill Hospitalized Patients: The Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment (SUPPORT),” JAMA, 274 (1995): 1591–98.CrossRefGoogle Scholar

Teno, J.M. et al., “Advance Directives for Seriously-Ill Hospitalized Patients: Effectiveness with the Patient Self-Determination Act and the SUPPORT Intervention,” Journal of the American Geriatrics Society, 45 (1997): 500–07; and Teno, J.M. et al., “Do Advance Directives Provide Instructions that Direct Care?,” Journal of the American Geriatrics Society, 45 (1997): 508–12.CrossRefGoogle Scholar

Fins, J.J., “Advance Directives and SUPPORT,” Journal of the American Geriatrics Society, 45 (1997): 519–20.Google Scholar

Fins, J.J. et al., “End-of-Life Decision-Making in the Hospital: Current Practices and Future Prospects,” Journal of Pain and Symptom Management, 17 (1999): 6–15.CrossRefGoogle Scholar