Surrogate Decision Making

Abstract

The literature of bioethics offers three different models for thinking about surrogates who make decisions on behalf of patients who cannot decide for themselves: the best interest model, the substituted judgment model, and the reasonable person model. Although there are significant differences between them, all three models rest on the unspoken presumptions that 1) surrogates should be treated just like the patient for whom they are deciding, and that 2) surrogate decisions should be regarded just like patient decisions. In this paper, we will challenge both of these presumptions. We will argue that surrogates should be treated differently from patients and that their decisions also have significantly different status. We will also argue that these differences give physicians important responsibilities for assessing the appropriateness of surrogates and for determining when to allow surrogate choices to rule.