Abstract
Emanuel criticizes the New Jersey Supreme Court's use of the substituted judgement standard, first laid down by the court in its 1976 Quinlan decision, in the 1987 Jobes ruling involving the withdrawal of artificially administered nutrition from a patient in a permanent vegetative state. Pointing out that the Jobes decision "barely acknowledges or answers the criticisms" of the substituted judgement standard, Emanuel argues that deciding what a person whose views concerning life-sustaining treatment are unknown or unclear would want if competent is "conceptually impossible." He acknowledges that American devotion to individual self-determination and governmental neutrality impedes the development of guidelines for terminating treatment for incompetent patients, and suggests that deliberation by local communities would allow the expression of diverse viewpoints and the embodiment of community values in standards to guide physicians and hospitals.
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