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Whose decision? Whose practice?
  1. Ho Mun Chan
  1. Correspondence to Dr Ho Mun Chan, Department of Public Policy, City University of Hong Kong, Tat Chee Avenue, Kowloon Tong, Hong Kong; sachm{at}

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The authors of this paper, Clarifying Substituted Judgment: The Endorsed Life Approach, alleged that respecting patient's autonomy is the primary goal of the current clinical practice.1 For incapacitated patients without definitive advance directives or with no advance directives at all, making decisions based on the substituted judgement standard (SJS) was regarded by the author as being widely accepted as the best way to pay due respect to the autonomy of such patients. According to the standard interpretation, the surrogate should make the decision that the incapacitated patient would have made if competent. However, there are critics who have argued that it is practically difficult to follow SJS and that the standard is theoretically unsound. It follows that SJS may need to be “significantly revised or abandoned altogether”1, but it has already been a standard part of clinical practice. The author believed that the challenges of the critics do not stem from SJS itself but from how it has been interpreted, and that the challenges can be met by adopting a better interpretation that is the endorsed life approach (ELA). According to this approach, the surrogate should make the decision in …

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  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

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