When a patient lacks decision-making capacity, who typically makes medical decisions?

• A. The patient alone always makes decisions.
• B. Surrogate decision-makers have no role.
• C. Decisions may be made by a legally authorized surrogate based on patient best interests or previously expressed wishes.
• D. Any family member can decide.

Answer: (C)

When someone cannot make medical decisions, a legally authorized surrogate makes those decisions for them. This surrogate bases choices on what the patient would have wanted (substituted judgment) or, if the patient’s wishes aren’t known, on the patient’s best interests and overall welfare. This approach protects patient autonomy even when the patient cannot speak for themselves.

In practice, surrogates are typically appointed through a durable power of attorney for health care, a court guardianship, or another legally recognized mechanism. Common potential surrogates include a spouse, adult child, parent, or other legally designated person. Advance directives or living wills also guide decisions, showing the patient’s preferences for treatment.

The other possibilities don’t fit because the patient cannot decide when capacity is lacking, and not every family member has the legal authority to decide; decisions must come from the legally authorized surrogate who is entrusted to represent the patient’s values and interests.