This schema has dominated legal thinking on the subject and has fostered a movement to make the use of advance directives much more widespread. Advance directives are thought to be far more reliable indicators of patient wishes than efforts at substituted judgment. Advance directives are usually seen to meet this evidentiary standard, while determinations made by substituted judgment are often not. This would seem to be only common sense, because a surrogate making a substitution of judgment is unlikely to know the patient's mind as well as the patient. Furthermore, challenges to the consensus regarding advance directives tend to be abstract philosophical problems.
Substituted judgment is undermined by empirical facts.
It is this latter issue that Jeffrey Blustein purportedly addresses. However, I want to call attention to the fact that his discussion makes clear a subtler and more clinically relevant insight. Namely, a reasonable narrative view of personal identity inverts the relationship between the two standards of decision making for incapacitated patients. That is, a narrative view of personal identity sees substituted judgment as the foundation of advance directives. To order the full text of this article, please go to ordering .