The health care team's question involves not just FB's
substituted judgment, but also the impact of caregiver burden on it.
It concluded that reversal of the probate court was required under the doctrine of
substituted judgment regardless of the patient's competency.
While the current law commands that they provide a
substituted judgment, natural law would reject such a one-size-fits-all approach.
Consequently, although some courts claim to apply the
substituted judgment standard in these cases, (108) others properly decline to engage in the fiction of doing so.
Regardless of that, if the case were such that she was fully lacking the capacity to make a decision about her medical treatment, we are under the obligation to respect the
substituted judgment of her health care proxy.
When
substituted judgment fails to supply clear answers, the best interest standard comes into play.
The loose
substituted judgment standard has been adopted by a number of courts.
166 (2006): 493-97) show that patient-designated and next-of-kin surrogates incorrectly identify patients' end-of-life wishes one-third of the time, which calls into serious question whether
substituted judgment is ethically appropriate.
The differences explain why ethical theorists and legal authorities give priority to advance directives over the
substituted judgment standard.
Substituted judgment is to be distinguished from a decision based on an advance directive.
Surrogate decision-makers will not do that, however, if they are encouraged to use the principle of
substituted judgment before that of best interest.
Much of the opposition to the Florida court rulings was built on weaknesses in the
substituted judgment standard.
