In the absence of an advance directive, which guidance best describes surrogate decision making for nutrition and hydration?

• A. Surrogates may decide based solely on their own values.
• B. Surrogates must consult a lawyer before deciding.
• C. Surrogates only consider financial implications.
• D. Surrogates may honor the patient's previously expressed wishes or act in the patient's best interests.

Answer: (D)

When no advance directive exists, surrogate decision making is anchored in the patient’s own preferences and welfare. If the patient’s wishes about nutrition and hydration are known, the surrogate should follow those expressed wishes. If the wishes aren’t known, the surrogate should act in the patient’s best interests, weighing potential benefits and burdens of continuing or withholding feeding and fluids, considering prognosis, quality of life, comfort, and dignity. This approach respects autonomy while also guiding care toward what would most likely benefit the patient.

This is why the recommended guidance is that surrogates may honor the patient’s previously expressed wishes or act in the patient’s best interests. It aligns decisions with what the patient would want and with overall well-being, rather than the surrogate’s own values, legal considerations, or financial concerns.