Which statement best describes the surrogate decision-maker's role when the patient's wishes are known?

• A. They should follow the patient’s known wishes (substituted judgment).
• B. They should prioritize the clinician's recommendations.
• C. They should always choose the most costly option.
• D. They should avoid discussing preferences with family.

Answer: (A)

When a patient’s wishes are known, the surrogate decision-maker uses substituted judgment to decide as the patient would have, honoring those expressed preferences and values. This approach respects the patient’s autonomy and guides care to align with what they would want, rather than following the clinician’s personal recommendations or choosing options based on cost alone. The surrogate should discuss and confirm understanding with family and clinicians to ensure the known preferences are applied, but the decision ultimately reflects the patient’s own wishes. If the wishes aren’t specific to the current situation, the surrogate then interprets them in light of the patient’s values; options that ignore the known wishes or rely on cost or clinician preference do not fit.