Living wills and substituted judgments: A critical analysis

Medicine, Health Care and Philosophy 4 (2):169-183 (2001)
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In the literature three mechanisms are commonly distinguished to make decisions about the care of incompetent patients: A living will, a substituted judgment by a surrogate (who may or may not hold the power of attorney ), and a best interest judgment. Almost universally, the third mechanism is deemed the worst possible of the three, to be invoked only when the former two are unavailable. In this article, I argue in favor of best interest judgments. The evermore common aversion of best interest judgments entails a risk that health care providers withdraw from the decision-making process, abandoning patients (or their family members) to these most difficult of decisions about life and death. My approach in this article is primarily negative, that is, I criticize the alleged superiority of the living will and substituted judgment. The latter two mechanisms gain their alleged superiority because they are supposedly morally neutral, whereas the best interest judgment entails a value judgment on behalf of the patient. I argue that on closer inspection living wills and substituted judgments are not morally neutral; indeed, they generally rely on best interest judgments, even if those are not made explicit



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References found in this work

Deciding for Others: The Ethics of Surrogate Decision Making.Allen E. Buchanan & Dan W. Brock - 1989 - New York: Cambridge University Press. Edited by Dan W. Brock.
The nature of suffering and the goals of medicine.Eric J. Cassell - 1991 - New York: Oxford University Press.
The Loss of Wholeness. [REVIEW]S. Kay Toombs - 2012 - Hastings Center Report 23 (6):41-42.
Wesen und Formen der Sympathie.Max Scheler - 1925 - Annalen der Philosophie Und Philosophischen Kritik 5 (3):100-101.
Deciding for Others.Gerald Dworkin, Allen E. Buchanan & Dan W. Brock - 1991 - Philosophical Quarterly 41 (162):118.

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