Who can give informed consent in cases where a patient lacks capacity, and what standards guide surrogate decisions?

• A. A legally authorized representative or surrogate makes decisions; standards include best interest, substituted judgment, and known patient preferences or advance directives.
• B. The nurse decides best interest when capacity is lacking.
• C. The family can decide with no formal standards.
• D. Informed consent is waived when patient lacks capacity.

Answer: (B)

When a patient cannot give informed consent, someone legally authorized to do so must make the decision on the patient’s behalf. The surrogate’s role is guided by established standards: act in the patient’s best interests, use substituted judgment if there is evidence about what the patient would have wanted, and honor any known preferences or advance directives the patient previously expressed. This framework preserves respect for the patient’s autonomy by translating their values into care decisions even when they can’t speak for themselves.

The nurse does not bear the ultimate decision-making authority. Instead, the nurse’s job is to provide clear information, help ensure the surrogate understands options, advocate for the patient’s values, and support a lawful, informed consent process. Consent isn’t waived; it’s obtained from the appropriate surrogate or, if no surrogate exists, guided by applicable professional and legal standards.