[Ethical criteria for substitute decision-making in people without capacity]

Area of Science:

• Bioethics
• Medical Law
• Patient Rights

Context:

• Healthcare decisions increasingly emphasize patient autonomy and informed consent.
• Challenges arise when patients lack decision-making capacity, requiring substitute decision-makers.
• Spanish law lacks clear criteria for guiding proxy decisions.

Purpose:

• To analyze three North American legal criteria for substitute decision-making: subjective, substitute judgment, and best interest.
• To examine the evolution and societal interpretation of the

Summary:

• The subjective criterion relies on patient directives (e.g., living wills).
• The substitute judgment criterion aims to replicate the patient's likely decision.
• The best interest criterion prioritizes the patient's well-being, traditionally emphasizing life preservation.

Impact:

• Highlights the need for updated legal and ethical frameworks for substitute decision-making in Spain.
• Proposes a re-evaluation of the