The Principle of Substituted Judgment

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The Principle of Substituted Judgment Traditionally, the physician was expected to use all of their talents and training in an effort to save the life of their patient, no matter the odds. More recently, the physician’s role has been redefined to preserve the autonomy of the patient. Now physicians must give life saving care only in so far and to the degree desirous of the competent patient. Until this century, it was rare that brain-dead patients could be kept alive for long periods of time. However, as technological prowess has increased, it has recently become possible to keep a patient alive without higher brain functioning for years and even decades. But, as is always the case with new technology and knowledge, previously unknown ethical issues arise, and thus we have the difficult ethical problems of the Karen Ann Quinlan case. There are many ethical issues that arise in the Karen Ann Quinlan case. First, there is the ethical right that each person has to receive or refuse medical treatment. But this can ethically problematic because some would see death as an intrinsic evil; therefore choosing death would be unethical. This, however, can be categorized as part of the larger issue of patient autonomy, the patient's right to live and abide by their own personal choices (Garrett 29). Recent thought has affirmed the idea of patient autonomy in medicine, now making it a central dogma of the American medical practice. In this case, patient autonomy is threatened because the patient is not able to communicate their desires for treatment. The physician cannot ask, and therefore cannot know, if the patient would want to continue treatment or withdraw treatment. In this case, the Karen was deemed incompetent... ... middle of paper ... judge if this principle does, indeed, safeguard the patient’s autonomy at all. At the same time, this is the only safeguard, other than living wills and the right of attorney, of an incompetent patient’s autonomy. As a result, the actual ethicality of the substituted judgment principle continues to be extremely controversial. Works Cited Garrett, Thomas, Baillie, Harold, and Garrett, Rosellen. Health Care Ethics; Principles and Problems. 4th Ed. Upper Saddle River, New Jersey. Prentice Hall, 2001. Kuczewski, Mark. "Reconceiving the Family: the Process of Consent in Medical Decision Making." Hastings Center Report. March-April 1996: 32-37. Van Camp, Julie. “Matter of Quinlan.” Law, Philosophy, and the Humanities. December 16th, 1996. California State University, Long Beach. November 9th, 2004. <>

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