How should decisions be guided when surrogates differ from patient values?

How should decisions be guided when surrogates differ from patient values?

• A. Surrogates can override patient values at any time.
• B. Surrogates have no role in decision-making.
• C. Surrogates or advance directives guide decisions to reflect patient values, with ongoing communication.
• D. Only courts can decide for the patient.

Answer: (C)

When surrogates and patient values differ, decisions should be guided by what the patient would have wanted, using the surrogate’s substituted judgment or an existing advance directive, with ongoing communication among the family and the medical team. Surrogates have a duty to try to reflect the patient’s known wishes and values, not to impose their own beliefs, and an advance directive provides explicit instructions that the care team should follow. If there is no directive, the surrogate should make decisions based on what the patient would have chosen given the situation, and if uncertainty remains, consider the patient’s best interests in light of their values while continuing discussions and reassessing as circumstances change. Judicial involvement or court decisions are not the default path; they’re only relevant if disputes cannot be resolved through discussion and the patient’s preferences remain unclear. So the best approach emphasizes following the patient’s values through the surrogate’s guidance or an advance directive, with ongoing communication to keep decisions aligned with those values.

When surrogates and patient values differ, decisions should be guided by what the patient would have wanted, using the surrogate’s substituted judgment or an existing advance directive, with ongoing communication among the family and the medical team. Surrogates have a duty to try to reflect the patient’s known wishes and values, not to impose their own beliefs, and an advance directive provides explicit instructions that the care team should follow. If there is no directive, the surrogate should make decisions based on what the patient would have chosen given the situation, and if uncertainty remains, consider the patient’s best interests in light of their values while continuing discussions and reassessing as circumstances change. Judicial involvement or court decisions are not the default path; they’re only relevant if disputes cannot be resolved through discussion and the patient’s preferences remain unclear.

So the best approach emphasizes following the patient’s values through the surrogate’s guidance or an advance directive, with ongoing communication to keep decisions aligned with those values.