Which statement best describes how ethics involvement occurs when patient lacks capacity?

• A. Assess capacity, involve a surrogate, apply best-interest or substituted judgment standards, document, and involve ethics as needed.
• B. Always defer to the most senior clinician.
• C. Delay decisions until the patient regains capacity.
• D. Ethics should never be involved; decisions are clinical only.

Answer: (C)

When a patient cannot participate in a decision, the process centers on honoring their autonomy as much as possible while ensuring timely, appropriate care. Start by assessing whether the patient has the capacity for the specific decision at hand—can they understand the information, appreciate the consequences, reason about options, and communicate a choice? If capacity is lacking, bring in a legally authorized surrogate to decide. The surrogate should use substituted judgment if there are known preferences from the patient, or, if those aren’t known, apply the best-interest standard to decide what would most protect the patient’s welfare. Document what was assessed, who the surrogate is, the standards used, and the reasoning behind the decision. When cases are ethically complex or contested, involve ethics consultation to help ensure decisions reflect the patient’s values while meeting clinical needs. Delaying decisions until capacity returns is not always feasible or appropriate, and decisions should not be made on clinical grounds alone without considering the ethical framework and the patient’s values.