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Living wills and substituted judgments: a critical analysis
1Center for Health Policy and Ethics, Creighton University, 2500 California Plaza, Omaha, NE 68178, USA. jwelie@creighton.edu
Medicine, Health Care, and Philosophy
|September 8, 2001
Summary
This study argues for the importance of best interest judgments in healthcare decisions for incompetent patients. It challenges the perceived superiority of living wills and substituted judgments, revealing their reliance on best interest considerations.
Area of Science:
- Medical Ethics
- Patient Care Decision-Making
Background:
- Three primary mechanisms guide healthcare decisions for incompetent patients: living wills, substituted judgment, and best interest judgments.
- Best interest judgments are typically considered the least desirable option, reserved for situations where other methods are unavailable.
Purpose of the Study:
- To advocate for the utilization of best interest judgments in patient care.
- To critique the commonly held view that living wills and substituted judgments are morally superior to best interest judgments.
Main Methods:
- Critical analysis of existing ethical frameworks for patient decision-making.
- Examination of the underlying assumptions and moral neutrality of different decision-making mechanisms.
Main Results:
- The aversion to best interest judgments risks healthcare providers disengaging from critical life-and-death decisions.
- Living wills and substituted judgments are not morally neutral and often implicitly incorporate best interest considerations.
Conclusions:
- Best interest judgments should be more readily considered and applied in healthcare decision-making for incompetent patients.
- The perceived moral superiority of living wills and substituted judgments is based on a flawed premise, as they frequently depend on best interest evaluations.