Bailey Susan
Faculty of Health and Behavioural Sciences, Deakin University, Geelong, Victoria, Australia.
Nurs Ethics. 2002 Sep;9(5):483-93. doi: 10.1191/0969733002ne538oa.
The substituted judgement principle is often recommended as a means of promoting the self-determination of an incompetent individual when proxy decision makers are faced with having to make decisions about health care. This article represents a critical ethical analysis of this decision-making principle and describes practical impediments that serve to undermine its fundamental purpose. These impediments predominantly stem from the informality associated with the application of the substituted judgement principle. It is recommended that the principles upon which decisions are made about health care for another person should be transparent to all those involved in the process. Furthermore, the substituted judgement principle requires greater rigour in its practical application than currently tends to be the case. It may be that this principle should be subsumed as a component of advance directives in order that it fulfils its aim of serving to respect the self-determination of incompetent individuals.
当替代决策者必须就医疗保健做出决策时，替代判断原则常被推荐为促进无行为能力个体自我决定的一种方式。本文对这一决策原则进行了批判性的伦理分析，并描述了一些实际障碍，这些障碍有损于其根本目的。这些障碍主要源于与替代判断原则应用相关的非正规性。建议在为他人做出医疗保健决策时所依据的原则，应对该过程中所有相关人员保持透明。此外，替代判断原则在实际应用中需要比目前更严格。或许该原则应被纳入预先指示的组成部分，以便实现其尊重无行为能力个体自我决定的目标。
