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Some comments on the substituted judgement standard.

Dan Egonsson1

  • 1Department of Philosophy, Lund University, Kungshuset 22222, Lund, Sweden. Dan.Egonsson@fil.lu.se

Medicine, Health Care, and Philosophy
|February 24, 2009
PubMed
Summary

This study reinterprets the substituted judgment standard (SJS) for end-of-life decisions. It proposes surrogates should infer patient thoughts, distinguishing consent from preference, to better uphold patient autonomy.

Area of Science:

  • Bioethics
  • Medical Law and Ethics
  • Philosophy of Medicine

Background:

  • The substituted judgment standard (SJS) guides treatment decisions for non-competent patients.
  • Traditional SJS requires surrogates to decide as the patient would have if competent.
  • Ethical frameworks (Kantian, utilitarian, virtue ethics) inform SJS interpretation.

Purpose of the Study:

  • To propose an alternative interpretation of the substituted judgment standard (SJS).
  • To differentiate between patient consent and preference in end-of-life decision-making.
  • To explore the justification of SJS within Kantian, utilitarian, and virtue ethical perspectives.

Main Methods:

  • Conceptual analysis of the substituted judgment standard (SJS).
  • Distinction between patient consent and preference in surrogate decision-making.

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  • Examination of ethical justifications for SJS from Kantian, utilitarian, and virtue ethics viewpoints.

    • Main Results:

    • An alternative SJS interpretation requires surrogates to infer the patient's actual thoughts on end-of-life decisions.
    • The relative importance of consent versus preference in SJS depends on the ethical framework applied.
    • Utilitarian justification hinges on the existence of surviving patient preferences.

    Conclusions:

    • SJS may be interpreted as a method to infer patient preferences and consent.
    • Virtue ethics highlights the tension between respect (consent) and care (preference).
    • SJS can serve as an independent normative method to extend patient autonomy from both Kantian and virtue ethical standpoints.