How should nurses approach decision-making when a patient lacks decision-making capacity?

• A. Assess capacity, involve a surrogate, apply best-interest or substituted judgment standards, document, and involve ethics as needed.
• B. Make decisions independently without patient or surrogate.
• C. Ignore ethical consultation.
• D. Delay decisions until the patient recovers capacity.

Answer: (A)

When a patient can’t make a medical decision, start by determining if they truly lack capacity for the specific situation: can they understand the information, appreciate the consequences, reason about options, and communicate a choice? If capacity isn’t present, bring in a legally authorized surrogate or family member to act as the decision-maker. Use substituted judgment to honor what the patient would have wanted based on known values and preferences; if those aren’t known, apply the best-interest standard to choose options that best promote the patient’s welfare, safety, and overall well-being, balancing benefits and harms. Document every step—the assessment, who was involved, the decisions made, and why—and seek ethics consultation when there’s disagreement, uncertainty, or ethical complexity. Reassess capacity periodically and revisit decisions if the patient’s capacity improves.

This approach respects autonomy as much as possible, protects the patient when autonomy isn’t available, and follows a clear, legally supported process. Making decisions independently without surrogates or ethics input can violate patient rights and legal authority, while delaying decisions until capacity returns may jeopardize timely and appropriate care.