Consent for a patient who cannot consent for himself

Correct answer: A. Autonomy

• A. CORRECT. AUTONOMY is the principle of self-determination — the patient's right to decide what happens to his own body. When residual cognitive deficits mean he can no longer exercise that right himself, it is EXERCISED ON HIS BEHALF by a legally authorised surrogate. A court-appointed guardian is the strongest form of that authority. The principle at stake is still autonomy; only the mechanism of expressing it has changed, ideally through substituted judgement based on what the patient himself would have wanted.
• B. Veracity is the duty of truthfulness, which governs how the treatment and its risks are explained. It does not confer authority to consent.
• C. Justice concerns fair distribution of care and resources, and non-discrimination. It is not engaged here.
• D. Beneficence is the duty to act for the patient's benefit. It underlies the recommendation to extract, but it is not the principle that makes the wife's signature valid — and beneficence without autonomy is precisely what paternalism means.

Note: The hierarchy of surrogates: a court-appointed guardian first, then a healthcare power of attorney, then the statutory next-of-kin order, which varies by jurisdiction. Being someone's spouse does not by itself confer authority in every state — here it does, because the court has appointed her.

Correct answer: A. An informed consent form

• A. CORRECT. INFORMED CONSENT is the documented result of a disclosure and decision process. The required elements are the diagnosis, the nature and purpose of the proposed treatment, its risks and benefits, the reasonable ALTERNATIVES with their risks and benefits, and the consequences of doing NOTHING — the last two being the ones most often omitted. Consent must be given voluntarily by a person with capacity or an authorised surrogate, and the signed form is evidence of the conversation, not a substitute for it.
• B. Informed refusal documents a patient's decision to DECLINE recommended treatment after the same disclosure. It is equally important to record but is not what happened here.
• C. A treatment plan is the clinical sequence of proposed procedures. It informs the consent discussion but carries no legal authorisation by itself.
• D. An advance directive is a document made in advance by a person with capacity, setting out their wishes for future care should they lose capacity. It is not created at the point of treatment.

Note: Consent is a PROCESS, not a signature. A signed form obtained without a genuine discussion does not protect anyone, and consent can be withdrawn at any point.