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"What the patient would have decided": A fundamental problem with the substituted judgment standard.

Broström, Linus LU ; Johansson, Mats LU and Nielsen, Morten Klemme LU (2007) In Medicine, Health Care and Philosophy 10(3). p.265-278
Abstract
Decision making for incompetent patients is a much-discussed topic in bioethics. According to one influential decision making standard, the substituted judgment standard, the decision that ought to be made for the incompetent patient is the decision the patient would have made, had he or she been competent. Although the merits of this standard have been extensively debated, some important issues have not been sufficiently explored. One fundamental problem is that the substituted judgment standard, as commonly formulated, is indeterminate in content and thus offers the surrogate little or no guidance. What the standard does not specify is just how competent one should imagine the patient to be, and what else one ought to envision about the... (More)
Decision making for incompetent patients is a much-discussed topic in bioethics. According to one influential decision making standard, the substituted judgment standard, the decision that ought to be made for the incompetent patient is the decision the patient would have made, had he or she been competent. Although the merits of this standard have been extensively debated, some important issues have not been sufficiently explored. One fundamental problem is that the substituted judgment standard, as commonly formulated, is indeterminate in content and thus offers the surrogate little or no guidance. What the standard does not specify is just how competent one should imagine the patient to be, and what else one ought to envision about the patient’s hypothetical outlook and the circumstances surrounding his or her decision making. The article discusses this problem of underdetermined decision conditions. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
autonomy - decision conditions - hypothetical consent - incompetence - substituted judgment - substituted judgment standard - surrogate decision making
in
Medicine, Health Care and Philosophy
volume
10
issue
3
pages
265 - 278
publisher
Springer
external identifiers
  • scopus:34548354865
ISSN
1572-8633
DOI
10.1007/s11019-006-9042-2
language
English
LU publication?
yes
id
7fc9632f-3827-4247-9f48-d0b764a7ee49 (old id 163036)
alternative location
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=17120112&dopt=Abstract
date added to LUP
2007-06-21 16:42:50
date last changed
2017-01-01 07:14:59
@article{7fc9632f-3827-4247-9f48-d0b764a7ee49,
  abstract     = {Decision making for incompetent patients is a much-discussed topic in bioethics. According to one influential decision making standard, the substituted judgment standard, the decision that ought to be made for the incompetent patient is the decision the patient would have made, had he or she been competent. Although the merits of this standard have been extensively debated, some important issues have not been sufficiently explored. One fundamental problem is that the substituted judgment standard, as commonly formulated, is indeterminate in content and thus offers the surrogate little or no guidance. What the standard does not specify is just how competent one should imagine the patient to be, and what else one ought to envision about the patient’s hypothetical outlook and the circumstances surrounding his or her decision making. The article discusses this problem of underdetermined decision conditions.},
  author       = {Broström, Linus and Johansson, Mats and Nielsen, Morten Klemme},
  issn         = {1572-8633},
  keyword      = {autonomy - decision conditions - hypothetical consent - incompetence - substituted judgment - substituted judgment standard - surrogate decision making},
  language     = {eng},
  number       = {3},
  pages        = {265--278},
  publisher    = {Springer},
  series       = {Medicine, Health Care and Philosophy},
  title        = {"What the patient would have decided": A fundamental problem with the substituted judgment standard.},
  url          = {http://dx.doi.org/10.1007/s11019-006-9042-2},
  volume       = {10},
  year         = {2007},
}