Living wills and substituted judgments: a critical analysis

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.