In surrogate decision-making, which factor best guides decisions for a patient who lacks capacity?

In surrogate decision-making, which factor best guides decisions for a patient who lacks capacity?

• A. Best interests only.
• B. Previously expressed wishes and values of the patient.
• C. Family convenience.
• D. Physician’s personal beliefs.

Answer: (B)

When a patient lacks capacity, the surrogate should act to honor what the patient would have wanted, based on previously expressed wishes and values. This approach, often called substituting judgment, uses advance directives, prior conversations, and known goals of care to guide decisions, ensuring care aligns with the person’s identity and priorities. If those prior wishes are clear, they trump other considerations and should be followed—even if they differ from what family members or clinicians might prefer. If there are no clear prior directives, then a best-interests assessment is used, weighing potential benefits and burdens to determine what would most promote the patient’s well-being. Choices driven by family convenience or a physician’s personal beliefs do not reflect the patient’s preferences and should not guide care.

When a patient lacks capacity, the surrogate should act to honor what the patient would have wanted, based on previously expressed wishes and values. This approach, often called substituting judgment, uses advance directives, prior conversations, and known goals of care to guide decisions, ensuring care aligns with the person’s identity and priorities. If those prior wishes are clear, they trump other considerations and should be followed—even if they differ from what family members or clinicians might prefer. If there are no clear prior directives, then a best-interests assessment is used, weighing potential benefits and burdens to determine what would most promote the patient’s well-being. Choices driven by family convenience or a physician’s personal beliefs do not reflect the patient’s preferences and should not guide care.