The Incapacitated Patient and Unfit Health Care Proxy: What to Do Next

Over the past 50 years, third-party agents have played an increasingly important role in making medical decisions for patients lacking decisional capacity. While these agents often protect patient autonomy, concerns sometimes arise regarding their fitness to serve. Unlike the well-established criteria for assessing patient capacity, guidelines for evaluating agent fitness remain limited. This article explores factors - both voluntary and involuntary - that may impair an agent's ability to represent a patient's wishes. It also emphasises the need for clinicians to address these concerns during emergencies and proposes a novel model to guide the assessment of third-party agent fitness in clinical settings.