Understanding Guardianship: Substituted Judgment vs. Best Interest

When someone can no longer make decisions for themselves, guardians step in to ensure those decisions are made with care, clarity, and compassion. But even with the best intentions, it isn’t always simple. Guardianship often involves balancing two core principles:

▪ Substituted Judgment
▪ Best Interest

These two frameworks guide how ethical, legal, and practical decisions are made—and knowing when to apply each is one of the most important responsibilities in this work.

What Is Substituted Judgment?

Substituted judgment means making decisions that reflect what the individual would have wanted if they were able to speak for themselves.

This approach relies on personal history, expressed preferences, values, and choices the individual made in the past. It recognizes that every person has the right to autonomy—and that right doesn’t disappear simply because capacity has changed.

A guardian using substituted judgment might:

• Honor a person’s previously stated wish to decline certain medical treatments
• Choose a living arrangement that matches their long-standing lifestyle
• Respect their cultural or spiritual practices in care decisions

It requires listening, remembering, and advocating. When there is a clear record of the person’s wishes, substituted judgment is the most respectful course of action.

When Best Interest Comes First

But what happens when there is no known preference? Or when a previously stated wish now creates a risk of serious harm?

That’s when the best interest standard comes in.

Best interest decisions are made based on what will most safely and effectively meet the person’s current needs. This often involves input from medical providers, family members, social workers, and the guardian team. It emphasizes well-being, safety, and stability.

Examples include:

• Approving a medical procedure when past wishes are unknown
• Moving someone from an unsafe living environment
• Making financial decisions to protect assets or prevent exploitation

The goal is to ensure the individual is cared for—especially when they can no longer direct that care themselves.

Navigating the Gray Area

In reality, guardianship rarely fits neatly into one category or the other.

There are moments when substituted judgment and best interest seem to conflict. For instance, an individual may have previously chosen to live independently no matter the risk—but after a decline in health, that choice may no longer be safe.

In those cases, guardians must weigh risk, rights, and relationships. They must ask:

• Does this decision reflect who this person was?
• Is there a way to honor their preferences while also ensuring safety?
• What would bring dignity to this moment?

It’s not always a perfect science. But it is a thoughtful process—one rooted in empathy, ethics, and a deep respect for the individual’s humanity.

Why It Matters

Substituted judgment and best interest aren’t just legal tools. They’re frameworks for compassionate decision-making. They help ensure that even when someone can’t speak for themselves, their story, values, and needs remain at the center.

In guardianship, we are not just making choices. We are protecting identity. Preserving dignity. And making sure every individual receives the care and respect they deserve. These decisions aren’t always easy. But when made with clarity and care, they become a powerful form of advocacy—the kind that truly honors the person behind every case.

At Nevada Guardian Services, we recognize the importance of whole-person care. Supporting mental and emotional well-being is central to how we serve vulnerable and elderly individuals. We walk alongside our clients and their families every step of the way—with compassion, respect, and a person-centered approach.