Substitute Decision Making
The orthodox view
Generally autonomy is seen as trumping beneficence, and this view aims to respect autonomy even when an individual cannot fully act on it.
However, for those who have never been competent, substituted judgment doesn’t seem applicable, because the patient has no history of autonomous decision making that we can rely upon.
Valid interests of the non-competent
It seems that the Best Interests principle creates one-size-fits all conception of the interests of those who aren’t autonomous. We already understand that children, for example, have extremely different preferences, and even though they might not grasp more complex decision making, can nonetheless provide sufficient basis for us considering their wishes beyond avoiding pain or prolonging life.
Threshold authority approach
This view assumes that it is possible for the older self to have authority over the current self if their capacity for autonomous decision making and authority is higher to a sufficient extent. The fundamental interests of such a current self are truly defined by the former self rather than her/him right now. Partially this idea comes from the fact that say the transformation from a person to a non-person leads to a lesser level of moral consideration and we must primarily respect the person (former self) rather than the non-person (current-self).
Forward Looking Perspective
Decision making inherently involves future and present oriented perspectives. It might be unfortunate that the past wishes are unfulfilled, but there is no use in catering to by-gone interests in current decision making.…
