| Summary: | Patients with disorders of consciousness after severe brain injury need surrogate decision-makers to guide treatment decisions on their behalf. Formal guidelines for surrogate decision-making generally instruct decision-makers to first appeal to a patient’s written advance directive, followed by making a substituted judgement of what the patient would have chosen, and lastly, to make decisions according to what seems to be in the patient’s best medical interests. Substituted judgement is preferable because it is taken to preserve patient autonomy, by using a patient’s past wishes and values to reconstruct what they would have chosen for themselves. However, I argue that at least in some cases, past values should not have authority for present decision-making, using patients with ‘covert awareness’ as a case study. Patients with ‘covert awareness’ may continue to have values and an authentic sense of self, which may differ from their past values and wishes. Accordingly, surrogate decision-makers should make decisions based on how the patient is likely to experience their condition in the present, rather than their past wishes and values.
|
|---|