  Concerning patients who have never been competent, the orthodox view, as it is typically interpreted, may be misleading in certain cases. By recommending the Best Interests standard as opposed to the Substituted Judgment standard, the orthodox view may help create the impression that, for those who have never had decision-making capacity, only a one-size-fits-all objective assessment of their interests, based on generic goals such as prolonging life or avoiding pain, is available. However, a person may lack decision-making capacity but nonetheless possess the proper starting points of decision-making, so that a surrogate could still reconstruct deeply personal and idiosyncratic choices on the person's behalf. Consider a child or a mildly retarded patient who lacks the capacity to make a sophisticated medical decision because she cannot fully grasp the complex consequences of the available options, or because, if left to her own devices, she would merely choose impulsively. Yet, very meaningful and personally distinctive issues may be at stake for this individual: for instance, alternative treatments may differently impact her relationships with loved ones or differently affect her ability to continue participating in deeply valued activities such as painting or dancing. In such cases, to best serve the interests of the patient, surrogates arguably need to reconstruct the subjective point of view of the patient, and not just fall back on generic choices that “a reasonable person” would make under the circumstances. In short, sometimes — especially in dealing with patients with rich inner lives whose decision-making is nevertheless impaired — the application of the Best Interests standard may look an awful lot like an exercise of Substituted Judgment.