What should a surrogate decision-maker do when a patient lacks capacity regarding medical decisions?

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Multiple Choice

What should a surrogate decision-maker do when a patient lacks capacity regarding medical decisions?

When a patient lacks capacity, decisions should reflect the patient’s own values and previously expressed preferences. This is substituted judgment: the surrogate asks what the patient would have wanted in this situation and bases choices on known values, advance directives, or prior conversations about goals of care. This respects autonomy even though the patient cannot speak for themselves and guides care to align with what the patient would have chosen. Relying solely on the clinician’s judgment overlooks the patient’s autonomy and previously stated wishes. A surrogate cannot unilaterally override a DNR order simply by making a decision; such directives or prior preferences guide those choices. And a surrogate’s decision is not irrelevant—the surrogate is the designated decision-maker precisely to apply the patient’s values to care when capacity is absent. If no preferences are known, the surrogate would then move to the patient’s best interests, considering the benefits, burdens, and likely quality of life.

When a patient lacks capacity, decisions should reflect the patient’s own values and previously expressed preferences. This is substituted judgment: the surrogate asks what the patient would have wanted in this situation and bases choices on known values, advance directives, or prior conversations about goals of care. This respects autonomy even though the patient cannot speak for themselves and guides care to align with what the patient would have chosen.

Relying solely on the clinician’s judgment overlooks the patient’s autonomy and previously stated wishes. A surrogate cannot unilaterally override a DNR order simply by making a decision; such directives or prior preferences guide those choices. And a surrogate’s decision is not irrelevant—the surrogate is the designated decision-maker precisely to apply the patient’s values to care when capacity is absent. If no preferences are known, the surrogate would then move to the patient’s best interests, considering the benefits, burdens, and likely quality of life.

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