{"title":"Substituted Judgment and The Paradigm Case Mistake.","authors":"Daniel Brudney","doi":"10.1080/15265161.2025.2457711","DOIUrl":null,"url":null,"abstract":"<p><p>Substituted judgment is widely used at the bedside, but the moral value that underpins its use needs examination. I argue that this value is the value of leading an authentic life. I then argue that an authentic life has multiple axes and that patients (like all human beings) vary widely in how they score on these axes. This entails that the moral weight of the value of authenticity in bedside decision-making also varies widely. And that means that, at the bedside, substituted judgment should not be seen as a moral trump. Put differently, when a surrogate must make a bedside decision, the answer to the \"What would the patient choose?\" question should not be morally decisive for that decision. The answer to that question should be a part, but only a part, of a more complex decision-making process.</p>","PeriodicalId":50962,"journal":{"name":"American Journal of Bioethics","volume":" ","pages":"1-8"},"PeriodicalIF":20.8000,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"American Journal of Bioethics","FirstCategoryId":"98","ListUrlMain":"https://doi.org/10.1080/15265161.2025.2457711","RegionNum":1,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ETHICS","Score":null,"Total":0}
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Abstract
Substituted judgment is widely used at the bedside, but the moral value that underpins its use needs examination. I argue that this value is the value of leading an authentic life. I then argue that an authentic life has multiple axes and that patients (like all human beings) vary widely in how they score on these axes. This entails that the moral weight of the value of authenticity in bedside decision-making also varies widely. And that means that, at the bedside, substituted judgment should not be seen as a moral trump. Put differently, when a surrogate must make a bedside decision, the answer to the "What would the patient choose?" question should not be morally decisive for that decision. The answer to that question should be a part, but only a part, of a more complex decision-making process.
期刊介绍：
The American Journal of Bioethics (AJOB) is a renowned global publication focused on bioethics. It tackles pressing ethical challenges in the realm of health sciences.
With a commitment to the original vision of bioethics, AJOB explores the social consequences of advancements in biomedicine. It sparks meaningful discussions that have proved invaluable to a wide range of professionals, including judges, senators, journalists, scholars, and educators.
AJOB covers various areas of interest, such as the ethical implications of clinical research, ensuring access to healthcare services, and the responsible handling of medical records and data.
The journal welcomes contributions in the form of target articles presenting original research, open peer commentaries facilitating a dialogue, book reviews, and responses to open peer commentaries.
By presenting insightful and authoritative content, AJOB continues to shape the field of bioethics and engage diverse stakeholders in crucial conversations about the intersection of medicine, ethics, and society.
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