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Substitute decision-making — MCCQE Part 1 MCQ

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ModerateEthics & ProfessionalismSubstitute decision-makingMCCQE Part 1

A 79-year-old man with advanced dementia is admitted with aspiration pneumonia and lacks capacity for treatment decisions. There is no advance directive. His daughter is the legally recognised substitute decision-maker. What is the most appropriate ethical/legal action?

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Correct answer: C — Ask the substitute decision-maker to decide using known wishes or best interests

When a patient lacks capacity, the recognised substitute decision-maker should apply prior capable wishes or the patient's best interests under provincial law. Physicians should provide medical recommendations and support decision-making. Lack of capacity does not mean treatment is withheld by default.

Reference: CMPA substitute decision-making guidance