Decision-Making Capacity and Surrogate Decision-Making for a Patient Who Lacks It

Abstract

Abstract When patients have decisional capacity (decision-making capacity), respect for autonomy requires that healthcare decisions made by the patient be honored. However, when a patient lacks or loses decisional capacity, either temporarily or permanently, healthcare professionals turn to a surrogate decision-maker who is charged with making decisions that align best with what the patient would choose if they had the ability to do so. Both ethics and the law provide guidance in this area. Surrogate decision-makers and healthcare professionals look first to the patient’s previously expressed preferences regarding their health and treatment. In the absence of such explicit known wishes, the surrogate decision-maker can help identify approaches that are most concordant with the patient’s values and views. When the surrogate decision-makers are not in agreement, or there is no identified surrogate decision-maker, the task of making important decisions about healthcare becomes even more complicated.