A standard of surrogate decision-making often employed by courts for making end-of-life decisions regarding incompetent patients. The term has been transferred analogously to refer to decision-making for any incapacitated patient whose prior wishes are unknown or impossible to determine. Lacking any evidence of the patient’s known wishes, values or convictions, it is the obligation of the surrogate to make decisions according to the best interests of the patient—that is, a good faith determination of what treatment would promote the patient’s overall greatest welfare, considering all relevant factors, and made in accordance with ethical and medical standards. The best interests standard necessarily applies to decisions made on behalf of individuals who have always been incompetent.
In determining what is in the patient’s best interests, the surrogate should consider, among other relevant information: 1) the patient’s current level of physical, sensory, emotional and cognitive functioning; 2) the degree of pain resulting from the patient’s medical condition, treatment or termination of the treatment; 3) the amount of humiliation, dependence and offence against dignity that will probably result from the patient’s condition and treatment; 4) the patient’s life expectancy and chance for recovery both with and without the treatment; 5) the treatment options available to the patient; 6) the risks, side effects and benefits of each of those treatment options. (Source: K. Reed of Dykema-Gossett, Detroit, MI, 1995.)