Abstract

This chapter discusses the moral framework for surrogate decision-making for incompetent medical patients. The chapter focuses on the question of how we can respect the autonomy of those who are no longer competent to make such decisions. The standard counterfactual account of how to respect the autonomy of the incompetent is evaluated, along with accounts that ground respect for autonomy on the patient’s most recent desires and values (regardless of whether the patient still possesses those desires and values) as well as accounts according to which only the current desires and values of the patient matter. Other issues discussed include whether questions of personal identity should affect decision-making for incompetent patients, whether a patient’s former desires and values factor in to the patient’s current well-being, and whether an incompetent patient’s “investment interests” should guide decisions on the patient’s behalf.