In ethical decision-making, when should surrogates be involved?

• A. When the patient cannot decide
• B. Only when the patient asks for surrogates
• C. Surrogates should not be involved
• D. Surrogates should be involved at all times

Answer: (A)

The key idea is that surrogate decision-makers come into play when the patient cannot make decisions themselves. When a patient lacks decision-making capacity—due to unconsciousness, delirium, or severe cognitive impairment—the surrogate’s role is to use substituted judgment or act in the patient’s best interests, guided by any known values, preferences, or an advance directive. This protects the patient’s autonomy by ensuring care aligns with what they would have wanted, even though they can’t express it at that moment. If the patient is able to decide, they should make the decisions themselves, and surrogates aren’t needed. Surrogates aren’t required every time or in every situation, and they shouldn’t be involved only at the patient’s request if the patient still has capacity; and they shouldn’t be excluded altogether.