The form of
surrogate decision-making regarding end-of-life care in which the surrogate attempts to establish with as much accuracy as possible what decision the patient would have made if that patient were competent to do so. This conclusion can be based on the patient’s preference expressed in previous statements or the surrogate’s knowledge of the patient’s values, beliefs, personality, and prior lifestyle. This standard seeks to preserve the patient’s right of self-determination by placing the patient’s own preferences at the center of deliberation, while recognizing that it is the exception rather than the rule that the patient will have articulated his or her preferences in advance. Substituted judgment is to be distinguished from a decision based on an
advance directive.
