A patient has an advanced directive stating a desire to forego medical technology, including nutrition and hydration, in order to prolong life. The patient is now in an irreversible vegetative state. In deciding whether to continue nutrition and hydration by medical means, the patient's surrogate decision maker must:

• A. Consult with a lawyer
• B. Honor the patient's expressed wish to withdraw nutrition and hydration by medical means
• C. Have a psychiatric evaluation to be declared competent to make any decisions in the patient's care
• D. Decide, based upon own values, to withdraw the patient's nutrition and hydration by medical means

Answer: (B)

Respect for patient autonomy and the authority of an advance directive guide decisions when the patient cannot decide. If the patient has an advance directive expressing a wish to forego medical technology, including nutrition and hydration, to prolong life, the surrogate must follow that directive. In this case, the patient is in an irreversible vegetative state, so the surrogate's duty is to withdraw nutrition and hydration consistent with the patient's stated wishes. There’s no need to consult a lawyer here, and a psychiatric evaluation to assess capacity isn’t necessary since the directive provides clear guidance and the patient cannot decide. Acting on the surrogate’s own values would override the patient’s autonomy.