Clarifying and defending the endorsed life approach to surrogate decision-making.
Clarifying and defending the endorsed life approach to surrogate decision-making.
复制标题
澄清并捍卫认可的替代决策生活方式。
DOI：
10.1136/medethics-2015-102950
复制
发表时间：
2015
影响因子：
4.1
通讯作者：
Wendler,David
中科院分区：
文献类型：
--
作者：
Phillips,John;Wendler,David
In our paper, we pointed to several problems, both practical and theoretical, with the Substituted Judgment Standard (SJS)—at least when the SJS is understood as literally requiring that surrogates always make the decision that the incompetent patient would have made, if competent. 1 These problems show that the SJS, so implemented, does not respect patient autonomy. Others have considered these same problems and found them decisive, concluding that the SJS ought to be abandoned. In contrast, we argued that the SJS is best understood not in terms of replicating the decision that the patient would make if competent, but in terms of the standard’s underlying purpose: respecting the patient’s values and allowing them to continue, as nearly as possible, the sort of life they found worth living for themselves. We called this the Endorsed Life Approach. Understood in this way, the SJS neither consists in nor always requires asking what the patient would decide if competent, and so is not subject to the same challenges; it also offers a way to respect the autonomy of patients even after they have become incapacitated. We believe that this way of thinking about the standard is consistent with how the SJS is often understood and applied in practice. Dresser and Chan question whether our approach represents a significant departure from the standard interpretation of the SJS. 2 3 Dresser notes that, given the messy realities of clinical practice, most surrogates and clinicians will respond to roughly the
