Differentiate between substituted judgment and best interests in surrogate decision-making.

• A. Substituted judgment reflects the patient’s known wishes; best interests focus on what would benefit the patient when wishes are unknown.
• B. Substituted judgment is about costs; best interests are about wishes.
• C. Best interests reflect known wishes; substituted judgment is about benefits.
• D. Substituted judgment is legal; best interests are ethical.

Answer: (A)

Substituted judgment asks the surrogate to decide as the patient would have decided, using the patient’s known wishes, values, and any prior statements or patterns of choices. Best interests is used when there are no reliable knowledge of the patient’s preferences; the decision then centers on what would most benefit the patient’s overall welfare, weighing factors like relief from suffering, prognosis, and quality of life. So the statement that substituted judgment reflects known wishes and best interests focus on what would benefit the patient when wishes are unknown is the best fit. The other ideas—emphasizing costs, or reversing which standard reflects wishes or benefits, or framing substituted judgment as legal rather than ethical—do not capture the proper distinction. In practice, use substituted judgment if there is clear evidence of preferences; if not, apply the best interests standard.