What is the appropriate approach to surrogate decisions when patient values are known?

• A. Follow surrogate wishes no matter what
• B. Always refuse surrogate input
• C. Use surrogate input but prioritize patient known values and best interests; document
• D. Do not involve surrogate in decision-making

Answer: (C)

When patient values are known, decisions should be guided by applying those values through substituted judgment while also weighing what’s in the patient’s overall best interests. The surrogate’s role is to convey what the patient would choose if able to speak for themselves, based on prior wishes and core values, and the clinician uses that input to inform the plan of care. This should be done transparently, with careful consideration of prognosis, risks and benefits, quality of life, and alignments with what the patient values as important. Thorough documentation of the surrogate input, the patient’s known values, and the reasoning behind the final decision helps ensure accountability and can guide future care if circumstances change. Surrogate input is important, but it is not followed unconditionally if it would conflict with the patient’s known values or best interests. If known values are unclear, decisions should still be guided by the patient’s best interests while continuing to involve the surrogate to clarify preferences. Choices that ignore known values or exclude surrogate input fail to honor patient autonomy and the ethical framework for surrogate decision-making.