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Underlying Assumptions and Potential Ramification of Having Proxy Subjective Health Status
Having proxy subjective health status or evaluation measures, particularly concerning the quality of life of children or individuals unable to speak for themselves, might be sought as a substitute for a patient’s self-assessment. According to Bertelli et al. (2019), proxy assessments are instrumental in addressing challenges regarding internal and external validities in health outcomes. The assessments could be used as substitutes for a patient’s self-assessment, particularly in clinical trials that include health-related quality of life (HRQL) outcomes, which could assist in avoiding the exclusion of patients unable to respond for themselves (Bertelli et al., 2019). Proxy assessments are essential to informing clinical decisions regarding patient care. This achievement could be realized by reinforcing information through self-assessment or providing complementary information concerning the patient.
One of the fundamental assumptions of having proxy subjective health status or evaluation measures for children or those unable to speak for themselves is that the proxy accepts the values and preferences shared by the patient. The assumption holds that the proxy can identify changes that might occur over a given period, depending on the views derived from the patient (Bertelli et al., 2019). Since proxy judgments are based on the patient’s quality of life provisions, the decisions made could significantly affect the care provided, including treatment methods used in evaluating the success of the type of care. Through a proxy, the patient’s values and preferences would be known, including changes that might be considered.
The ramifications of having proxy subjective health status or evaluation measures for the population under consideration would include the challenges experienced by proxies in making decisions and assuming responsibility for the judgments made. According to Shepherd (2022), proxies are required to receive and comprehend information regarding the condition of a patient, applicable legal frameworks, and the wishes and feelings regarding a patient’s participation in a study needed to improve their quality of life. Proxies might find it challenging to determine a patient’s preferences in practice, which might lead to the development of the proxies’ emotional and decisional difficulties. For instance, which the increasing prevalence of conditions such as dementia, including critically ill patients with Covid-19, it would be difficult for proxies to make decisions regarding the most effective way through which research could be carried out to determine solutions to health concerns of subject patient populations. The ramifications account for the idea that the proxy decision-making process is regarded as an individual endeavor, even though evidence exists concerning the notion that the process is relational and significantly contextualized in practice.
Bertelli, M. O., Bianco, A., Rossi, A., Mancini, M., La Malfa, G., & Brown, I. (2019). Impact of severe intellectual disability on proxy instrumental assessment of quality of life. Journal of Intellectual & Developmental Disability, 44(3), 272-281.
Shepherd, V. (2022). (Re)conceptualizing ‘good’ proxy decision-making for research: The implications for proxy consent decision quality. BMC Medical Ethics, 23(1). https://doi.org/10.1186/s12910-022-00809-5