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Clarifying substituted judgement: the endorsed life approach
John Phillips1, David Wendler2
1Department of Philosophy, University of North Carolina, Chapel Hill, North Carolina, USA.
Journal of Medical Ethics
|November 1, 2014
Summary
Respecting patient autonomy is crucial. A new interpretation of the substituted judgment standard, the 'endorsed life' approach, offers a practical way for surrogates to make treatment decisions for incompetent patients.
Area of Science:
- Bioethics
- Medical Law
- Clinical Practice
Background:
- Respecting patient autonomy is a primary goal in clinical practice.
- The substituted judgment standard guides surrogates in making treatment decisions for patients lacking decision-making capacity.
- Recent critiques question the feasibility and theoretical underpinnings of the standard interpretation.
Purpose of the Study:
- To analyze criticisms of the substituted judgment standard.
- To propose an alternative interpretation that upholds patient autonomy.
- To introduce the 'endorsed life' interpretation for clinical application.
Main Methods:
- Critical analysis of existing literature on substituted judgment.
- Examination of theoretical and practical challenges in surrogate decision-making.
- Comparative analysis of the 'endorsed life' interpretation with other proposed alternatives.
Main Results:
- Criticisms often stem from the common interpretation, not the standard itself.
- The 'endorsed life' interpretation provides a viable framework for respecting patient autonomy.
- This approach offers a practical solution without necessitating radical changes to clinical practice.
Conclusions:
- The substituted judgment standard does not require abandonment or significant revision.
- An 'endorsed life' interpretation effectively promotes respect for the autonomy of incompetent patients.
- This interpretation aids clinicians and surrogates in navigating complex treatment decisions.
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