skip to main content

Substitute decision-maker — MCCQE Part 1 MCQ

Instant feedback + full explanation. One question, done properly.

ModerateEthics & ProfessionalismSubstitute decision-makerMCCQE Part 1

82-year-old woman with advanced dementia presents with pneumonia requiring treatment decision. She lacks capacity and previously named her daughter as substitute decision-maker. Which of the following is the most appropriate next step?

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

Reveal the answer and explanation

Correct answer: D — Ask the daughter to decide based on prior capable wishes or best interests

Ask the daughter to decide based on prior capable wishes or best interests is best because SDMs should follow known wishes or best interests. Breach confidentiality broadly without legal basis is suboptimal because disclosure must be limited to what is legally authorised or clinically necessary; Let family preference override a capable patient is suboptimal because capable patients direct their own care; Refuse to discuss the issue and document nothing is suboptimal because professional practice requires communication and clear documentation; Delay a mandatory report until certainty is absolute is suboptimal because statutory reporting thresholds are often suspicion or reasonable belief, not proof. Family does not make decisions by preference hierarchy if a lawful SDM exists.

Reference: CMPA consent and substitute decision-making guidance