Substituted Judgment: The Limitations of Autonomy in Surrogate Decision Making
First Online: 10 July 2008 Received: 17 January 2008 Revised: 30 April 2008 Accepted: 21 May 2008 DOI:
Cite this article as: Torke, A.M., Alexander, G.C. & Lantos, J. J GEN INTERN MED (2008) 23: 1514. doi:10.1007/s11606-008-0688-8 Abstract
Substituted judgment is often invoked as a guide for decision making when a patient lacks decision making capacity and has no advance directive. Using substituted judgment, doctors and family members try to make the decision that the patient would have made if he or she were able to make decisions. However, empirical evidence suggests that the moral basis for substituted judgment is unsound. In spite of this, many physicians and bioethicists continue to rely on the notion of substituted judgment. Given compelling evidence that the use of substituted judgment has insurmountable flaws, other approaches should be considered. One approach provides limits on decision making using a best interest standard based on community norms. A second approach uses narrative techniques and focuses on each patient’s dignity and individuality rather than his or her autonomy.
KEY WORDS decision making end-of life substituted judgement surrogate References
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