Substituted judgment: The limitations of autonomy in surrogate decision making

Alexia M. Torke, G. Caleb Alexander, John Lantos

Research output: Contribution to journalReview article

80 Scopus citations

Abstract

Substituted judgment is often invoked as a guide for decision making when a patient lacks decision making capacity and has no advance directive. Using substituted judgment, doctors and family members try to make the decision that the patient would have made if he or she were able to make decisions. However, empirical evidence suggests that the moral basis for substituted judgment is unsound. In spite of this, many physicians and bioethicists continue to rely on the notion of substituted judgment. Given compelling evidence that the use of substituted judgment has insurmountable flaws, other approaches should be considered. One approach provides limits on decision making using a best interest standard based on community norms. A second approach uses narrative techniques and focuses on each patient's dignity and individuality rather than his or her autonomy.

Original languageEnglish (US)
Pages (from-to)1514-1517
Number of pages4
JournalJournal of general internal medicine
Volume23
Issue number9
DOIs
StatePublished - Sep 1 2008

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Keywords

  • Decision making
  • End-of life
  • Substituted judgement
  • Surrogate

ASJC Scopus subject areas

  • Internal Medicine

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