Substituted Judgment: The Limitations of Autonomy in Surrogate Decision Making

Torke, Alexia; Alexander, G.; Lantos, John
September 2008
JGIM: Journal of General Internal Medicine;Sep2008, Vol. 23 Issue 9, p1514
Academic Journal
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.


Related Articles

  • Power to the Patient. Meyer, Harris // H&HN: Hospitals & Health Networks;Feb2010, Vol. 84 Issue 2, p40 

    The article focuses on a shared decision-making project to educate medical specialists about the risks and benefits of treatment options. The author notes that patients view videos about their conditions and then discuss their options with specialists. The project was implemented after research...

  • Practitioners Must State The Case For Complementary and Alternative Medicine. Eaton, Richard // Positive Health;Jan2011, Issue 178, p1 

    The article emphasizes that complementary and alternative medicine (CAM) practitioners should aggressively market the efficacy of their treatments to counter the negative media bias and regulatory challenges. It is stressed that failure to do so would seriously compromise the development of the...

  • Communicating Evidence for Participatory Decision Making. Epstein, Ronald M.; Alper, Brian S.; Quill, Timothy E. // JAMA: Journal of the American Medical Association;5/19/2004, Vol. 291 Issue 19, p2359 

    Context Informed patients are more likely to actively participate in their care, make wiser decisions, come to a common understanding with their physicians, and adhere more fully to treatment; however, currently there are no evidence-based guidelines for discussing clinical evidence with...

  • Predecisional information distortion in physicians' diagnostic judgments: Strengthening a leading hypothesis or weakening its competitor? Nurek, Martine; Kostopoulou, Olga; Hagmayer, York // Judgment & Decision Making;Nov2014, Vol. 9 Issue 6, p572 

    Decision makers have been found to bias their interpretation of incoming information to support an emerging judgment (predecisional information distortion). This is a robust finding in human judgment, and was recently also established and measured in physicians' diagnostic judgments (Kostopoulou...

  • WHAT DO PATIENTS WANT? Halpert, Julie // Newsweek;4/28/2003, Vol. 141 Issue 17, p63 

    Offers the author's experience in making a major medical decision during her preparation for breast-reconstruction surgery. Discussion of how one can take control of one's medical care by taking time to get the information needed to make an informed decision; Opinion that too many patients...

  • STUDY SHOWCASES VALUE OF SHARED DECISION MAKING.  // For the Record (Great Valley Publishing Company, Inc.);Nov2013, Vol. 25 Issue 15, p29 

    The article provides information on the results of the study conducted by "The Journal of Bone and Joint Surgery" on the effect of patient's enhanced knowledge on their medical condition in medical decision making. The study looked at 123 advanced knee and hip osteoarthritis patients with...

  • Planned Visits to Help Patients Self-manage Chronic Conditions. Bodenheimer, Thomas // American Family Physician;10/15/2005, Vol. 72 Issue 8, p1454 

    Explains the significance of planned visits to self-management support administered by health care professionals. Elements of self-management support; Factors which prevent primary care physicians to provide information and engage in collaborative decision making in the multiple-agenda visit;...

  • Cost is Not Transparent. Katz, Matthew C. // Connecticut Medicine;May2012, Vol. 76 Issue 5, p313 

    The author comments on a need for transparency of information and availability of accurate information in the medical decision-making process. According to the author, several smart shopper websites that claim to evaluate physicians are providing worthless and hazardous information to patients....

  • Partners in Prevention. Hampton, Tracy // JAMA: Journal of the American Medical Association;1/28/2004, Vol. 291 Issue 4, p415 

    Mentions a report by the U.S. Preventive Services Task Force. Idea that decision making pertaining to preventive care should be shared between physicians and their patients; Recommendation that clinicians provide patients with the pros and cons of various interventions before a course of action...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics