Approaches to surrogate decision making
| Standard interpretation of SJS | Authentic life (Brudney) | Substituted Interests (Sulmasy and Snyder) | Family interests (Chan) | Endorsed life | |
|---|---|---|---|---|---|
| Goal | Do as the patient would do | Continue the life the patient led | Promote the patient's best interests | Promote the family's interests | Promote the life the patient valued |
| Implementation | Choose the option that the patient would choose, if competent | Choose the option that best balances the authenticity of the patient's life with competing considerations | Choose the option that promotes the patient's interests, as informed by their preferences and values | Family makes decision collectively | Choose the option that best realises the life the patient valued for themselves |
| Is the life the patient lived relevant? | Yes, as evidence of what the patient would have done | Yes; try to continue the same life. | Yes, as evidence of what's in the patient's interests | Only to the extent it is relevant to the family | Yes, as evidence of what the patient valued |
| Are family preferences relevant? | No | Possibly, because family preferences may outweigh the importance of promoting an authentic life | Only if satisfying family preferences is in patient's best interests | Yes, family preferences matter regardless of what the patient wanted | Yes, to the extent the life the patient endorsed for themselves includes concern for their family's welfare. |
| Role of advance directives | Take priority over SJS | Take priority over SJS | Provide evidence of what is in the patient's best interests | Generally not used | Take priority over SJS |
SJS, substituted judgment standard.