Substituted Judgment: Best Interests in Disguise

Abstract

Several influential recent court rulings involving treatment decisions by legal guardians for incompetent patients have relied on a "substituted judgment" standard, in which the guardian attempts to decide vicariously what the ward would choose if competent, rather than a "best interests" standard based on determining what would be preferable for the well-being of the patient. Gutheil and Appelbaum analyze the difficulties inherent in applying the substituted judgment model of decision making and conclude that it raises more ethical concerns than the best interests model. (KIE abstract)