Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.
In our paper, we pointed to several problems, both practical and theoretical, with the Substituted Judgment Standard (SJS)—at least when the SJS is understood as literally requiring that surrogates always make the decision that the incompetent patient would have made, if competent.1 These problems show that the SJS, so implemented, does not respect patient autonomy. Others have considered these same problems and found them decisive, concluding that the SJS ought to be abandoned. In contrast, we argued that the SJS is best understood not in terms of replicating the decision that the patient would make if competent, but in terms of the standard's underlying purpose: respecting the patient's values and allowing them to continue, as nearly as possible, the sort of life they found worth living for themselves. We called this the Endorsed Life Approach. Understood in this way, the SJS neither consists in nor always requires asking what the patient would decide if competent, and so is not subject to the same challenges; it also offers a way to respect the autonomy of patients even after they have become incapacitated. We believe that this way of thinking about the standard is consistent with how the SJS is often understood and applied in practice.
Dresser and Chan question whether our approach represents a significant departure from the standard interpretation of the SJS.2 ,3 Dresser notes that, given the messy realities of clinical practice, most surrogates and clinicians will respond to roughly the same concerns “no matter which interpretation of substituted judgment holds sway”. She concludes that “properly interpreted, the original formulation of substituted judgment is a justifiable and workable approach”. Chan claims that our Endorsed Life Approach does not “significantly differ from the standard interpretation” since, in implementing the standard interpretation, the surrogate must take into account …
Provenance and peer review Commissioned; internally peer reviewed.
- Feature article
Read the full text or download the PDF:
Other content recommended for you
- Clarifying substituted judgement: the endorsed life approach
- Substituted decision making and the dispositional choice account
- Advance decisions in dementia: when the past conflicts with the present
- Response to commentaries: ‘autonomy-based criticisms of the patient preference predictor’
- Treating competent patients by force: the limits and lessons of Israel’s Patient’s Rights Act
- Consent for anaesthesia
- In the patient’s best interest: appraising social network site information for surrogate decision making
- Autonomy-based criticisms of the patient preference predictor
- Patients, doctors and the good life (for the patient)
- Juggling law, ethics, and intuition: practical answers to awkward questions