When a patient cannot make decisions, which standard guides surrogate decision-making?

• A. Best-interest or substituted judgment standards.
• B. Always rely on physician’s preferences.
• C. Ignore patient and surrogate.
• D. Delay decisions indefinitely.

Answer: (A)

When someone can’t make their own medical decisions, decisions are guided by surrogate decision-making standards. There are two main approaches: substituted judgment and best-interest. Substituted judgment tries to reflect what the patient would have wanted if they could decide—using any known wishes, advance directives, or the values they’ve expressed in the past. If those aren’t known, the decision shifts to the best-interest standard, focusing on what would most promote the patient’s welfare, weighing benefits and burdens, prognosis, and quality of life.

In practice, the surrogate should use any prior statements, directives, or identified values to guide choices, and involve the health care team to interpret those wishes. If there are no known preferences, the surrogate looks to what would most benefit the patient, avoiding treatments that only prolong suffering without meaningful benefit. Relying on the physician’s own preferences, ignoring the patient or surrogate, or delaying decisions indefinitely aren’t appropriate standards.