Substituted judgment: the limitations of autonomy in surrogate decision making
Torke, A. M., Alexander, G. C., & Lantos, J. (2008). Substituted judgment: the limitations of autonomy in surrogate decision making. Journal of General Internal Medicine, 23 (9): 1514-7.
Abstract: Substituted judgment is often invoked as a guide for decision making
when a patient lacks decision making capacity and has no advance
directive. Using substituted judgment, doctors and family members try
to make the decision that the patient would have made if he or she were
able to make decisions. However, empirical evidence suggests that the
moral basis for substituted judgment is unsound. In spite of this, many
physicians and bioethicists continue to rely on the notion of
substituted judgment. Given compelling evidence that the use of
substituted judgment has insurmountable flaws, other approaches should
be considered. One approach provides limits on decision making using a
best interest standard based on community norms. A second approach uses
narrative techniques and focuses on each patient's dignity and
individuality rather than his or her autonomy.
(My publication)Posted: Thursday, January 22, 2009