TableĀ 1

Approaches to surrogate decision makingĀ 

Standard interpretation of SJSAuthentic life (Brudney)Substituted Interests (Sulmasy and Snyder)Family interests (Chan)Endorsed life
GoalDo as the patient would doContinue the life the patient ledPromote the patient's best interestsPromote the family's interestsPromote the life the patient valued
ImplementationChoose the option that the patient would choose, if competentChoose the option that best balances the authenticity of the patient's life with competing considerationsChoose the option that promotes the patient's interests, as informed by their preferences and valuesFamily makes decision collectivelyChoose 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 doneYes; try to continue the same life.Yes, as evidence of what's in the patient's interestsOnly to the extent it is relevant to the familyYes, as evidence of what the patient valued
Are family preferences relevant?NoPossibly, because family preferences may outweigh the importance of promoting an authentic lifeOnly if satisfying family preferences is in patient's best interestsYes, family preferences matter regardless of what the patient wantedYes, to the extent the life the patient endorsed for themselves includes concern for their family's welfare.
Role of advance directivesTake priority over SJSTake priority over SJSProvide evidence of what is in the patient's best interestsGenerally not usedTake priority over SJS
  • SJS, substituted judgment standard.