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Substituted decision making and the dispositional choice account
  1. Anna-Karin Margareta Andersson1,
  2. Kjell Arne Johansson2
  1. 1Department of Philosophy, Faculty of Humanities, Social Sciences and Education, The University of Tromsø, Tromsø, Norway
  2. 2Department of Global Public Health and Primary Care, The University of Bergen, Bergen, Norway
  1. Correspondence to Dr Anna-Karin Margareta Andersson, Department of Philosophy, Faculty of Humanities, Social Sciences and Education, The University of Tromsø, Tromsø N-9037, Norway; anna-karin.m.andersson{at}


There are two main ways of understanding the function of surrogate decision making in a legal context: the Best Interests Standard and the Substituted Judgment Standard. First, we will argue that the Best Interests Standard is difficult to apply to unconscious patients. Application is difficult regardless of whether they have ever been conscious. Second, we will argue that if we accept the least problematic explanation of how unconscious patients can have interests, we are also obliged to accept that the Substituted Judgment Standard can be coherently applied to patients who have never been conscious at the same extent as the Best Interests Standard. We then argue that acknowledging this result is important in order to show patients respect.

  • applied and professional ethics
  • autonomy
  • clinical ethics
  • competence/incompetence
  • decision-making

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  • Contributors The article is authored by A-KMA and KAJ.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement There is no additional unpublished data.

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