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This paper investigates how surrogate decision-making can undermine patient autonomy due to uncertainties and self-interest.

June 21, 2026Bioethics NewsOpen Access

Autonomy under uncertainty: the structural limits of substituted judgment in clinical practice

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This conceptual analysis explores surrogate decision-making challenges, highlighting ethical concerns around autonomy in incapacity.

This paper investigates how surrogate decision-making can undermine patient autonomy due to uncertainties and self-interest.
Conceptual analysis of the substituted judgment standard.
Examination of a clinical case from interventional radiology.
Development of criteria for autonomy reconstruction under uncertainty.
Identified vulnerabilities in surrogate motives that threaten substituted judgment.
Proposed criteria for evaluating surrogate testimony and understanding decisional capacity.
Argued for the need for institutional safeguards to uphold patient autonomy.

Boris Nikolic (2026) studied this question.

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