Informed consent for a patient who lacks decision-making capacity, what is appropriate?

• A. Proceed with treatment without consent.
• B. Let the patient decide alone despite capacity.
• C. Seek consent from a surrogate decision-maker or family member when appropriate.
• D. Postpone care indefinitely.

Answer: (C)

When a patient cannot make medical decisions, you don’t obtain consent from the patient alone. The appropriate route is to identify a surrogate decision-maker who has the legal authority to consent on behalf of the patient, such as a family member or a legally authorized healthcare proxy. This surrogate uses the patient’s previously stated wishes (substituted judgment) or, if those wishes are unknown, makes decisions in the patient’s best interests. If there is an advance directive or a durable power of attorney for health care, follow it. In true emergencies, implied consent may apply to provide life-saving treatment while you obtain surrogate input.

Proceeding without consent isn’t appropriate in non-emergency situations because it bypasses autonomy and can have legal and ethical consequences. Letting the patient decide alone isn’t possible when capacity is lacking. Postponing care indefinitely isn’t acceptable either, as delaying needed treatment can cause harm.