  The most straightforward challenge emphasizes that decision-making inherently involves a present- and future-oriented perspective: the surrogate must make the best decision for the patient in front of him about how to manage this patient's life from now on. The patient may have had different interests in the past, but how can these be relevant to current decisions, which can only affect the present and future but not the past? This approach may accept it as unfortunate that the patient's past interests were left unfulfilled, but insists that this unfortunate fact cannot be remedied, and that there is no use in catering to bygone interests in current decision-making (Dresser 1986).