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Some comments on the substituted judgement standard
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Some comments on the substituted judgement standard
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Some comments on the substituted judgement standard
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Journal Article
Some comments on the substituted judgement standard
2010
Overview
On a traditional interpretation of the
substituted judgement standard
(SJS) a person who makes treatment decisions on behalf of a non-competent patient (e.g. concerning euthanasia) ought to decide as the patient would have decided had she been competent. I propose an alternative interpretation of SJS in which the surrogate is required to infer what the patient actually thought about these end-of-life decisions. In clarifying SJS it is also important to differentiate the patient’s
consent
and
preference
. If SJS is part of an autonomy ideal of the sort found in Kantian ethics, consent seems more important than preference. From a utilitarian perspective a preference-based reading of SJS seems natural. I argue that the justification of SJS within a utilitarian framework will boil down to the question whether a non-competent patient can be said to have any surviving preferences. If we give a virtue-ethical justification of SJS the relative importance of consent and preferences depends on which virtue one stresses—respect or care. I argue that SJS might be an independent normative method for extending the patient’s autonomy, both from a Kantian and a virtue ethical perspective.
