Advance directives, substituted judgment, and the best-interest standard all have limitations that constrain their usefulness in making medical decisions for patients who cannot choose for themselves.
A medical student’s desire to practice the specialty that he or she finds most interesting should not outweigh the right of patients in a pluralistic society to receive a full range of legal medical services.
New brain imaging suggests that asking patients to put themselves in their surrogates’ shoes when thinking about advance directives might lead to directives that better line up with what surrogates think they should decide.
Advance directives do not always resolve questions about the best care for patients who no longer have decision-making capacity; physicians and patient surrogates can take alternative approaches to arrive at the best care decision.
There is a market for direct-to-consumer genetic testing and a need for better consumer information and more regulation of tests and testing laboratories.