Substituted judgement is justifiable when the patient is:

• A. Autonomously capable
• B. No longer autonomous
• C. Fully informed
• D. Able to communicate but not decide

Answer: (B)

Substituted judgment is used when the patient cannot make their own medical decisions anymore, so a surrogate decides based on what the patient would have chosen given their values and prior wishes. The best fit is that the patient is no longer autonomous. Autonomy requires decision-making capacity; when that capacity is lost, decisions should aim to reflect the patient’s preferences through substituted judgment. If the patient were still autonomously capable, the decision would come from them directly. Being fully informed helps, but capacity—not just information—determines whether substituted judgment applies. Even if someone can communicate but cannot decide due to impaired capacity, the appropriate approach hinges on whether autonomy has been lost.