Which statement best reflects a fundamental principle of ethical decision-making in critical care?

• A. Respect for autonomy, beneficence, nonmaleficence; involve surrogates when patient cannot decide
• B. Fidelity
• C. Justice only
• D. Veracity only

Answer: (A)

In critical care, decisions are guided by honoring the patient’s values and preferences while ensuring actions are beneficial and not harmful, especially when the patient cannot decide for themselves. This means respecting autonomy, which requires involving the patient’s known wishes or using a surrogate decision-maker when capacity is lacking. At the same time, clinicians strive to promote good (beneficence) and avoid harm (nonmaleficence) in every intervention, weighing potential benefits against risks and burdens. Involving surrogates when the patient cannot decide helps align care with the patient’s values and goals, ensuring that the chosen path reflects what matters most to them.

Other ethical elements like fidelity (trust and keeping commitments), justice (fair distribution), and veracity (truth-telling) are essential components of ethical practice, but the statement that explicitly combines autonomy, beneficence, nonmaleficence, and surrogate involvement best captures how ethical decision-making is approached in the critical care context.