Revising the Substituted Judgement Standard
Journal of Clinical Ethics. 1995 Spring; 6(1): 30-38.
In medical practice, it is not uncommon that patients who are incompetent make decisions regarding their treatment; indeed, as North America's elderly population grows and dementia and mental incapacity increase correspondingly, such instances are sure to increase markedly. The courts and medical ethicists have tended to agree that, whenever possible, decisions about the medical treatment of incompetent patients should be made by a surrogate, and those surrogates must be guided by concern for the patient's well being and by respect for the patient's autonomy. Various principles have been formulated to assist surrogates in arriving at decisions that will meet the constraints implied by these values; perhaps the most significant of these is the substituted judgment standard (SJS). The fundamental idea underlying this principle is that a surrogate should make the same decision that the patient would have made in the same circumstances were the patient competent to do so. Although this principle has been widely endorsed (in one form or another), I shall argue that the usual forms of the SJS fail to attain the goals for which they were designed, and I will recommend a new formulation.
Advance Directives; Allowing to Die; Attitudes; Autonomy; Competence; Consent; Decision Making; Dementia; Ethicists; Family Members; Forms; Goals; Informed Consent; Life; Motivation; Paternalism; Patient Care; Patients; Prolongation of Life; Standards; Substituted Judgment; Terminal Care; Third Party Consent; Treatment Refusal; Uncertainty; Values;
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Egonsson, Dan (2010-02)On a traditional interpretation of the substituted judgement standard (SJS) a person who makes treatment decisions on behalf of a non-competent patient (e.g. concerning euthanasia) ought to decide as the patient would have ...