Underlying Assumptions and Potential Ramifications of Having Proxy

Underlying Assumptions and Potential Ramifications of Having Proxy

Governments and scientists have historically sought to obtain vital data and metrics from humans. This data is acquired either through interaction with the subjects or direct observation. However, when working with children and adults with disability, it can be difficult to interact with or observe them. As a result, it prompts investigators to use their parents, family members or friends. Using the proxy involves examining a single set of data regarding one direct phenomenon to obtain information on another through correlation (Shepherd, 2022). It is essential to set up a framework to help healthcare experts and caregivers understand what is hurting the children and adults who cannot communicate.      

Different Assumptions can be made when applying various theoretical frameworks and concepts, such as proxy subjective health status. One of the assumptions is that the subjective health status is temporal, which means it is possible to experience a change in the subjects/patients’ understanding and judgments as they transition into a healthy life. Developing a framework is crucial for the health care provider to support children and adults who cannot speak (Shepherd et al., 2022). The extent and capability to assess and measure children and adults without the ability to communicate their health status to a physician is an underlying assumption that helps establish a proxy subjective health status of such individuals. The other assumption is that the proxy can consume someone else’s quality of life, values and priorities. Nevertheless, these values and priorities change with time and experiences, and psychological phenomena such as coping and adaptation can alter them. The transformations can be critical in modifying the perceived quality of life. There is an assumption that the potential confounding aspects have little effect on the proxy variables. For instance, it is assumed that high cases of maltreatment among disabled children are due to poverty and not to other factors such as willful neglect and abandonment.      

Based on these assumptions, several ramifications can arise for having evaluation measures for children or proxy subjective health status. Errors in the initial data and findings manifested in the proxy phenomena and variables are a major ramification. Thus, if data on a given phenomenon is wrong, it implies the outcomes would be wrong (Roydhouse et al., 2022). Thus, directly correlating information on one phenomenon with another could be difficult. The other ramification is that the proxy responds to subjective well-being, commonly among children and adults unable to communicate. The proxy lacks direct access to the needed information and relies on indirect cues and personal knowledge of the person. These are intrinsically undependable for such a purpose (Lapin et al., 2021). Proxies cannot make fair-minded judgments due to systemic personal biases when making subjective well-being estimates.                     


Lapin, B., Thompson, N., Schuster, A., & Katzan, I. (2021). Optimal Methods for Reducing Proxy-Introduced Bias on Patient-Reported Outcome Measurements for Group-Level Analyses. Circulation: Cardiovascular Quality and Outcomes, 14, e007960. https://doi.org/10.1161/circoutcomes.121.007960

Roydhouse, K, J., Cohen, M., Eshoj, H. R., & Corsini, N. (2022). The use of proxies and proxy-reported measures: a report of the international society for quality of life research (ISOQOL) proxy task force. Quality of Life Research, 31 (3). https://doi.org/10.1007/s11136-021-02937-8

Shepherd, V. (2022). (Re) Conceptualizing ‘good’ proxy decision-making for research: the implications for proxy consent decision quality. BMC Medical Ethics, 23, 75. https://doi.org/10.1186/s12910-022-00809-5.

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