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Substitute decision-maker hierarchy — MCCQE Part 1 MCQ

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ModerateEthics & ProfessionalismSubstitute decision-maker hierarchyMCCQE Part 1

An unconscious 82-year-old man needs urgent surgery for bowel perforation. He has no advance directive available; his spouse is present and knows his values. Which of the following is the most appropriate consent approach if delay would increase risk?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Seek consent from the legally authorized substitute decision-maker, or proceed under emergency doctrine if no SDM is available in time

When a patient lacks capacity, clinicians use the provincial substitute decision-maker hierarchy and known wishes/best interests. In a true emergency where consent cannot be obtained in time, treatment may proceed to prevent serious harm. Privacy and dignity must be maintained.

Reference: CMPA consent and substitute decision-maker guidance; provincial legislation