A 75-year-old client who has a history of end stage renal failure and advanced lung cancer recently had a stroke. In this situation, what is the appropriate next step regarding decision-making?

A 75-year-old client who has a history of end stage renal failure and advanced lung cancer recently had a stroke. In this situation, what is the appropriate next step regarding decision-making?

• A. The patient should decide all care independently
• B. The physician should decide all care
• C. The family should decide the course of care
• D. Determine who is legally empowered to make decisions

Answer: (D)

When a patient may not be able to participate in decisions, the key point is identifying who is legally authorized to decide for them. After a stroke, the patient’s decisional capacity might be compromised, so the next step is to assess capacity and, if it’s lacking, determine the legally empowered surrogate who can make healthcare choices on the patient’s behalf. This surrogate is usually someone designated by a durable power of attorney for healthcare or a court-appointed guardian, and they should make decisions in line with the patient’s values and any known wishes. The physician should inform and discuss recommendations with the patient (if capable) and involve the family, but they do not automatically have decision-making authority. If an advance directive or living will exists, it guides the chosen surrogate’s actions.

When a patient may not be able to participate in decisions, the key point is identifying who is legally authorized to decide for them. After a stroke, the patient’s decisional capacity might be compromised, so the next step is to assess capacity and, if it’s lacking, determine the legally empowered surrogate who can make healthcare choices on the patient’s behalf. This surrogate is usually someone designated by a durable power of attorney for healthcare or a court-appointed guardian, and they should make decisions in line with the patient’s values and any known wishes. The physician should inform and discuss recommendations with the patient (if capable) and involve the family, but they do not automatically have decision-making authority. If an advance directive or living will exists, it guides the chosen surrogate’s actions.