What is the role of a surrogate decision-maker when a patient lacks capacity?

• A. They guide decisions based on patient values; document rationale.
• B. They can override any medical advice without basis.
• C. They must obtain court approval before any decision.
• D. They have no role by law.

Answer: (A)

When a patient cannot make decisions, the surrogate acts as the patient’s voice, guiding care to reflect the patient’s values and preferences. The standard used is substituted judgment: if the patient’s wishes are known, the surrogate should follow them; if not known, decisions should aim for the patient’s best interests, considering prognosis, benefits and burdens of treatments, and overall quality of life. The surrogate works with the medical team to review options, obtain consent, and document the rationale for chosen plans so there’s a clear record of why those decisions reflect the patient’s values. They should not override medical advice without a legitimate basis grounded in the patient’s known wishes or best interests. Court approval before every decision isn’t typically required; court involvement is reserved for disputes or when there is no appropriate surrogate, depending on the jurisdiction.