When a patient lacks capacity, who typically makes medical decisions on their behalf?

• A. A legally authorized representative or surrogate
• B. The nurse on duty
• C. The patient after consent
• D. The attending physician always without input

Answer: (A)

When a patient lacks decision-making capacity, a legally authorized representative or surrogate makes medical decisions on their behalf. This person is designated by law or by an advance directive to act in the patient’s best interests and to use substituted judgment to reflect what the patient would have wanted. The surrogate could be a durable power of attorney for health care, a legally appointed guardian, or a close family member under applicable rules. The nurse on duty does not have authority to decide for the patient; the attending physician leads care but must involve the surrogate and honor any known patient preferences. The patient cannot consent when incapable, and decisions are not made solely by the physician, though in emergencies clinicians may proceed under implied consent to preserve life or prevent harm while awaiting surrogate input.