How should conflicts between patient autonomy and family wishes be resolved?

• A. Always follow family wishes, regardless of patient capacity.
• B. Let the court decide in every case.
• C. Ignore both and proceed with physician's own judgment.
• D. Prioritize patient autonomy when the patient has capacity; if not, follow surrogate decisions and ethics guidance.

Answer: (D)

When conflicts arise between a patient’s right to decide and family wishes, the patient’s autonomy is the starting point. If the patient has decision-making capacity, their preferences should guide the medical choices, even if the family disagrees. Capacity means the patient can understand the situation, appreciate consequences, reason about options, and communicate a clear choice.

If the patient cannot make decisions, decisions should come from a surrogate who knows the patient’s values or from ethics-guided processes. Use the patient’s previously stated wishes or advance directives as the best guide, and when those aren’t known, apply substituted judgment (trying to decide as the patient would) or, if that isn’t possible, the best interests standard. Ethics guidance or consultations can help resolve disputes when surrogates and clinicians disagree.

Other approaches miss essential safeguards: always following family wishes ignores the patient’s rights; leaving decisions to the court in every case is impractical and may delay care; and relying solely on the physician’s judgment denies patient and family input.