Ethics & Law · patient case question
His wife can sign the consent form under which ethical principle?
Patient case: Consent for a patient who cannot consent for himself
Patient: Male, 74 years old, in a wheelchair
Chief complaint: Wife: “He's here for his extractions.”
History: Hypertension, hyperlipidaemia. Stroke two years ago with residual cognitive deficits. His wife is the court-appointed legal guardian. Medications: lisinopril, atorvastatin, warfarin.
Findings: Non-restorable teeth #30 and #31 planned for extraction today.
Show answer and explanation
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.