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Honoring Chosen Family: Revisiting the Doctor-Proxy Relationship.

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    The Journal of Clinical Ethics
    |November 18, 2025
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    Summary

    Nancy Dubler

    Area of Science:

    • Bioethics
    • Medical Law
    • Patient Advocacy

    Background:

    • Nancy Neveloff Dubler's work significantly impacted bioethics, particularly concerning surrogate decision-making for incapacitated patients.
    • Her 1999 publication, "The Doctor-Proxy Relationship: An Untapped Resource," explored patient-physician-proxy dynamics.
    • Recommendations from this work are now integral to current best practices in healthcare.

    Purpose of the Study:

    • To analyze the ethical, legal, and procedural aspects of surrogate decision-making.
    • To examine the historical dynamics in patient-physician-proxy collaborations.
    • To evaluate the recognition and prioritization of different types of patient proxies.

    Main Methods:

    • Analysis of the 1999 publication "The Doctor-Proxy Relationship: An Untapped Resource."

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  • Review of historical dynamics in healthcare decision-making.
  • Identification of themes from focus groups with physicians and patient proxies.

    • Main Results:

    • Dubler's work highlighted the importance of the doctor-proxy relationship in surrogate decision-making.
    • The study identified key themes and provided recommendations that are now standard practice.
    • A critical finding is the disparity between inclusive recognition of proxies and state guidelines that often prioritize kinship over chosen relationships.

    Conclusions:

    • Current state guidelines for surrogate decision-making often exclude or deprioritize non-kin proxies, despite their established relationships with patients.
    • Relying solely on traditional family structures overlooks the ethical legitimacy and practical suitability of chosen families and friends.
    • There is a need to re-evaluate surrogate hierarchies to ethically and legally recognize the importance of chosen relationships in patient care.