If a patient lacks decision-making capacity and the family requests withholding care, who should guide decisions?

• A. The physician makes the decision alone
• B. Surrogate decision-makers, guided by known patient wishes
• C. Family members' personal desires override patient wishes
• D. The nurse makes the decision

Answer: (B)

When a patient can’t make decisions, someone legally authorized to speak for them must guide what happens next—the surrogate decision-maker. This person represents the patient’s values and prior wishes, ideally following any advance directives or living will the patient left. If there are clear statements about what the patient would want in serious or end-of-life situations, those directives guide the course of care.

If there are no explicit wishes, the surrogate uses substituted judgment—that is, deciding as the patient would have chosen based on known values and beliefs. If that can’t be determined, decisions shift to the patient’s best interests, weighing the potential benefits and burdens of treatment and quality of life. Throughout, the medical team provides information and support, but the surrogate (not the family’s personal desires) directs what should be done, in alignment with the patient’s preferences. The nurse supports care decisions but does not make them independently.