Changing the Question

Bibliographic Data

ID20337478
AuthorsDaniel Brudney (0000-0003-0463-437X, corresponding author)
Year2019
Volume49
Issue2
Pages9-16
Publication date2019-03-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueThe Hastings Center Report (JOURNAL)
Journal identifiersISSN: 0093-0334 • E-ISSN: 1552-146X
PublisherWiley (PUBLISHER • GB)
DOI10.1002/hast.988
PMID30998280
OpenAlexW2936339351
LanguageEN
Citations received2
References cited14

Jack, who is seventy‐five years old, is in the hospital with a terminal condition that has undermined his cognitive faculties. He has left no advance directive and has never had a conversation in which he made his treatment wishes remotely clear. Yet now, a treatment decision must be made, and in modern American medicine, the treatment decision for Jack is supposed to be made by a surrogate decision‐maker, who is supposed to use a decision‐making standard known as “substituted judgment.” According to the substituted judgment standard, Jack’s surrogate decision‐maker, his wife, is supposed to decide on his treatment by determining what Jack would do if he did have decisional capacity. That is, she is supposed to answer the question, what would the patient choose? I will argue that this is the wrong question to ask because when the question has a determinate answer, that answer is sometimes not sufficiently connected to the value that is supposed to make the question morally salient, and because sometimes, perhaps often, there is no determinate answer to the question of what the patient would choose. Jointly, these two problems suggest the need for a different question

Ambiguity · Conversation · Decision maker · Directive · Economics · Epistemology · Management science · Political science · Value (mathematics) · Wife · Computer Science · Ethics and Legal Issues in Pediatric Healthcare · Ethics in medical practice · Law · Patient Dignity and Privacy · Philosophy · Psychology · Social Psychology

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