Background The impact of advance directives in the context of medical durable powers of attorney can be dangerously overstated. Proxies, once appointed, are largely untrained and unprepared for their tasks and obligations.

Aim I hope to alert advocates and practitioners to the importance of explaining limitations of advance directives, as well as advantages. I will call for development of a proxy education template and present a preliminary draft for critique and discussion.

 Methods Comparative examples and literature review.

Results Discussion and reports in medical literature indicate substantial room for improvement implementing advance directives through a proxy’s informed and proactive involvement.

Discussion Advance directives can influence treatment but cannot ordain outcomes or guarantee results. Unrealistic expectations can lead to serious conflict among proxies, families, and health care providers and result in harm to the patient. Various models of the doctor-patient relationship have emerged, involving different conceptions of informed consent and informed refusal of treatment. A proxy’s effectiveness within any given model can be enhanced by education following the proxy’s selection.

Conclusion To achieve maximum positive impact, advance directives deserve attention to preparing proxies for effective involvement. Proxy education involves acquiring information, practicing action, and understanding the functions and limitations of advance directives in the context of the doctor-patient relationship.