What is a surrogate decision-maker, and what standards guide their decisions?

• A. Standards include substituted judgment and best interests.
• B. Only the patient's prior explicit written directive guides decisions.
• C. A surrogate should always overrule patient wishes.
• D. Surrogates have no defined standards.

Answer: (A)

A surrogate decision-maker is someone trusted to make medical choices for a patient who can’t make them themselves. The standards guiding their decisions are substituted judgment and best interests. Substituted judgment means trying to make the choice the patient would have made if they could, using what you know about the patient’s values, past statements, beliefs, and preferences. This preserves the patient’s autonomy by honoring their own wishes. Best interests comes into play when the patient’s preferences aren’t known. Here, the decision aims to promote overall well-being, minimize suffering, and weigh benefits and burdens to choose what would most likely benefit the patient given their situation and prognosis.

If there is an advance directive, the surrogate should follow it. If not, apply substituted judgment based on known values; if those aren’t known, use best interests to guide the decision. The idea is to respect autonomy when possible and to protect welfare when it isn’t.