In surrogate decision-making, what demonstrates respect for patient autonomy?

• A. Follow surrogate wishes even if they conflict with patient preferences
• B. Engage the surrogate in discussion while prioritizing patient known values and best interests, and document directives
• C. Ignore surrogate input
• D. Delay decisions until patient regains capacity

Answer: (B)

Respect for patient autonomy in surrogate decision-making means aiming to make choices that reflect what the patient would have chosen if able to decide for themselves. The best approach is to involve the surrogate in open discussion, gather and consider the patient’s known values and any previously stated preferences or advance directives, and document those directives and the reasoning behind decisions. This approach applies the substituted judgment standard: act as the patient would have, using their values and prior statements as a guide. If the patient’s wishes aren’t known, decisions should still be guided by the patient’s best interests, again informed by their values. Documenting directives ensures transparency and accountability for future care. Choices that follow the surrogate’s wishes when they conflict with the patient’s known preferences, ignore the surrogate input, or delay decisions undermine autonomy and may lead to care the patient would not have chosen.