In situations where the patient lacks capacity but a legally designated surrogate exists, which action best respects self-determination?

• A. Respecting surrogate decisions over prior patient wishes
• B. Consulting the legally designated surrogate as authorized by the client
• C. Refusing to involve any surrogate
• D. Proceeding with decisions without patient input

Answer: (B)

When a patient can’t express preferences, decision-making should shift to someone the patient designated to speak for them. A legally designated surrogate has the authority to guide or make medical choices on the patient’s behalf and should do so in a way that honors the patient’s known wishes or, if those aren’t known, the patient’s best interests. By consulting that surrogate, you’re upholding self-determination because you’re ensuring decisions reflect what the patient would have wanted, as expressed or authorized in advance documents or by the patient’s designated representative. If there are clear prior wishes, those guide the care; if not, the surrogate applies substituted judgment to reflect the patient’s values. Proceeding without input or bypassing the surrogate would fail to honor the patient’s autonomy, and disregarding the surrogate’s authority would misapply the established plan for who represents the patient.