E.M. Forster's novel Howard's End might be seen as a parable of proxy decisionmaking that underscores the need for the sort of proposal Linda and Ezekiel Emanuel make. The book is full of salutary warnings against relying on families to be good stewards of the interests of their incapacitated members. When the dying Mrs. Wilcox bequeaths her beloved home to Margaret Schlegel, an acquaintance she has become fond of, the Wilcox family actually suppresses the old lady's last will and testament rather than allow the house, Howard's End, to pass to an outsider. Things do turn out all right, of course: Margaret becomes the second Mrs. Wilcox and so comes into her inheritance despite the family's machinations. But as such happy coincidences seem even less likely in medicine than in other areas of life, the moral for bioethicists would seem to be, Beware of families. But Howard's End is a cautionary tale for theorists of proxy decisionmaking on a subtler level, as well. Would the ghost of the first Mrs. Wilcox be satisfied with the knowledge that her last wishes were carried out through a twist of fate? It seems unlikely. She didn't just want Margaret to have Howard's End - she wanted to give it to her as her gift, as an expression of her agency. The outcome was as she would have wished it, but it was not through her action that the outcome was achieved. This suggests that good proxy decisionmaking has two key elements (at least): anticipating what the incapacitated person herself would have wanted, and putting those desires into action in a way that expresses the person's authority to make decisions for herself. As we see it, the Emanuels' creative proposal might very well put us in a better position respecting the preferences of the patient. But if proxy decisionmaking really is justified on the grounds that it allows those who can't choose for themselves to exercise their autonomy - an odd notion on its face - then it will need to concern itself with preserving the patient's agency. Mrs. Wilcox's ghost is not the sole witness to the claim that autonomy makes no sense without agency; imagine your own reaction if your physician excluded you from involvement in health care decisions on the grounds that computerized expert systems were available that could accurately anticipate your preferences. It seems implausible that many of us would be altogether content to resign the whole matter to prescient machines; what gets lost is just what we mean by |agency' or |authority.' We are not claiming that the Emanuels' proposal is altogether insensitive to this second element of proxy decisionmaking. The community standards approach doesn't replace written treatment directives, despite their obvious limitations, or explicitly authorized proxies, despite all the current concern about their relative unreliability as predictors of patient preferences. This suggests that accuracy is not the only relevant matter here. Further, the requirement that the group meet and discuss the results of the treatment preference surveys gives members of the community the opportunity to dissent from or endorse the choices, underscoring the importance of being an agent. The difficulty, of course, is that, just as not everyone is going to make an advance directive, not everyone is going to go to the meetings. Some patients will join the community and then require a default decision before the community meetings have taken place; others will skip the meetings because of ill health or disinclination; some will attend, but not fully participate. And some will have no choice at all about what health care institution will be taking care of them and so will feel alienated from that community of patients. …