skip to main content

Decision-making capacity and surrogate decision-making — ABIM Board MCQ

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

HardGeneral Internal MedicineDecision-making capacity and surrogate decision-makingABIM Board

An 84-year-old man with metastatic lung cancer, delirium from hypercalcemia, and no decision-making capacity refuses IV fluids. His chart names his daughter as health care proxy. She says he previously stated that he wanted reversible problems treated but no CPR or intubation. Which of the following is the most appropriate management?

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

Reveal the answer and explanation

Correct answer: E — Use substituted judgment through the health care proxy while treating reversible delirium

When a patient lacks capacity, the authorized surrogate uses substituted judgment based on known values and prior statements. Reversible causes of incapacity should be treated, and code status should reflect the patient's goals rather than clinician preference.

Reference: AMA Code of Medical Ethics; ACP Ethics Manual