How should you handle a patient who lacks decision-making capacity?

• A. Involve surrogate decision-makers, assess capacity regularly, document findings, provide information in accessible formats, and follow legal and institutional guidelines.
• B. Proceed with treatment without consent
• C. Delay treatment indefinitely
• D. Ignore patient capacity and rely on staff preference

Answer: (A)

When someone can’t make medical decisions for themselves, the approach is to work through surrogate decision-makers while systematically checking capacity, documenting the process, and following laws and policies. Capacity is decision-specific and can vary over time, so you assess whether the patient understands the information, appreciates the consequences, can reason about options, and can communicate a choice. If the patient once expressed their wishes or has a designated health care proxy or advance directive, those guides should be followed. If there is no known directive, decisions should be made based on the patient’s best interests, considering their values and beliefs as far as can be known, and with input from family or other surrogates as appropriate.

Regular reassessment is important because capacity can improve or decline, and decisions should rotate back to the patient if capacity returns. Provide information in plain language and in accessible formats, and use interpreters if needed, ensuring the patient (or surrogate) fully understands the options. Document the capacity assessment, who is involved, what information was given, and the rationale for the final decision. Follow legal and institutional guidelines to avoid violations of rights and safeguards, and seek ethics or legal consultation if disputes arise or if there’s uncertainty about best interests.

Other approaches that bypass surrogate input or patient rights—such as proceeding without consent, delaying indefinitely, or ignoring capacity in favor of staff preference—undermine autonomy and ignore established legal and ethical standards, potentially causing harm and liability.