Liz Dzeng
speaker
457 appearances
3 recordings
1 series
first heard Oct 2020
last heard Dec 2023
Liz Dzeng’s voice in public audio — every appearance, attributed to the second.
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family member or a surrogate if the patient no longer has the capacity to make decisions on their own.
So substituted judgment basically is that that surrogate makes decisions based on what they think the patient would have wanted if they were able to speak for themselves.
So based on what they know about the patient's goals and values and prior life experiences, uh they're supposed to make that decision.
Obviously that can be very challenging sometimes.
So um so as I mentioned, uh there are four ethical principles, um, you know, autonomy being one of them.
And I think that my my own sense is that these um ethical principles should be equals.
And so, you know, it's not that autonomy is more important than beneficence and non-maleficence, they all should be uh considered equally.
And so an alternative would be to think about
Uh, these issues from perhaps a best interest standard, which is actually what's done in other countries.
So, for example, in the United Kingdom, uh, if a patient loses a capacity to make decisions, uh, there's actually a mental capacity act of 20 uh 2005 uh that states that decisions should be made on a best interest standard.
So you're sort of the the doctor actually has the uh ability to make decisions based on what's clinical.
In the best interest of the patient.
And now, of course, like there's a lot of critiques about that, especially from Americans who think about that.
They're like, well, how does the, you know, that's very like sort of.
uh paternalistic in fact for the doctor to say this is what's in the patient's best clinical interest.
But um, you know, there are certain things that, you know, we we can make clinical judgments and and there's they should also take into account the patient's best interest.
I mean, sorry, the patient's goals and values and what the family wants and that sort of thing.
But ultimately you can think about, you know, what's in the patient's best interest.
That's one way.
And there's
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