Clinical Ethics > Volume 4, Number 4 > Pp. 208-210

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Substituted misjudgement

Jennifer A Woo  and Kenneth M Prager  

Columbia University College of Physicians and Surgeons, 161 Fort Washington Avenue, Herbert Irving Pavilion 310, New York, NY 10032, USA

E-mail: pragerk{at}gmail.com

Substituted judgement is often used in the absence of advanced directives to guide decision-making when patients lack decisional capacity. We present a remarkable case of family members exercising substituted misjudgement for a 42-year-old man hospitalized with multiorgan failure on life support. Feeling that their loved one would rather die than face severe disability, they elected to withdraw life support. Although this was done, the patient remained alive and recovered enough to clearly indicate his preference for life, even with severe disability. This case suggests that in instances of unusual quality-of-life judgements where the patient's wishes cannot be known with reasonable certainty, families and physicians should be very wary using substituted judgement to refuse life support. Unless there are strong considerations based on the patient's prior statements, actions and values to decline life support, it would seem ethically appropriate to continue treatment, even with substantial disability the likely outcome.

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