When a patient lacks decision-making capacity, how should autonomy and guardians be addressed in ethical decision-making?

• A. Involve guardians appropriately, address consent and assent.
• B. Always override patient wishes.
• C. Exclude family from decisions.
• D. Make decisions alone.

Answer: (A)

When a patient cannot make their own medical decisions, the ethical approach centers on respecting autonomy by guiding care through a surrogate who can speak for the patient, usually a guardian or legally designated decision-maker. Guardians or surrogates should review the patient’s known wishes, values, and beliefs and provide informed consent on the patient’s behalf. It’s important to seek the patient’s assent whenever possible, communicating in a way the patient can understand and checking that they remain engaged in the decision to the extent they can. If the patient’s preferences are known, substitute judgment should reflect those priorities; if not, decisions should be guided by the patient’s best interests, including weighing benefits, burdens, and potential harms. Include family and loved ones in discussions as appropriate and follow legal and institutional guidelines for surrogate decision-making. This approach honors autonomy while ensuring care is beneficent and avoids unilateral decisions that ignore the patient’s rights and values.