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Substitute decision-making — RCPSC IM MCQ

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HardGeneral IM, Ethics, CanMEDSSubstitute decision-makingRCPSC IM

A patient with advanced dementia lacks capacity for an ICU decision and has no written directive. One child recalls repeated prior statements refusing life support; another requests intubation. What is the best next step?

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

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Correct answer: A — Use the authorized substitute and apply prior wishes or best interests

The best answer is “Use the authorized substitute and apply prior wishes or best interests”. Canadian consent law uses the legally authorized substitute decision-maker, who should follow applicable prior capable wishes and otherwise the patient’s best interests. Family disagreement does not create a vote and does not justify abandoning time-sensitive care.

Reference: Canadian Medical Protective Association, Consent: a guide for Canadian physicians: https://www.cmpa-acpm.ca/en/advice-publications/handbooks/consent-a-guide-for-canadian-physicians