substituted judgement
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Introduction
Inferring from a patient's earlier statements or actions, what choices that person would now make if he/she was still able to express an autonomous decision.
Such inferences are most authentic when an individual has clearly stated explicit preferences at a time he/she was still competent.
Pitfalls:
- it may be difficult to infer from a patient's previous state- ments his/her attitude towards an intervention not previously contemplated
- there is no assurance that the person's preferences have not changed over time
- surrogate decision makers may substitute there own values for the patient's preferences
- family members may stand to gain financially from medical decisions
It is the physician's role to remain the patient's advocate to ensure the decisions made by surrogates is in the patient's best interest.
Additional terms
References
- ↑ Kapp M & Finucane T. Decision Making, In: Comprehensive Geriatric Assessment, Osterweil et al eds, McGraw-Hill, New York, pg 595
- ↑ Pope TM. Making medical decisions for patients without surrogates. N Engl J Med. 2013;369:1976-1978 PMID: https://www.ncbi.nlm.nih.gov/pubmed/24256375
- ↑ Should Clinicians Give Recommnedations? GeriPal - A Geriatrics and Palliative Care Blog. http://www.geripal.org/2011/08/should-clinicans-give-recommendations.html