A 75-year-old patient with end-stage renal failure, advanced lung cancer, and a recent stroke: which action is most appropriate to determine decision-making authority?

• A. Determine who is legally empowered to make decisions
• B. Have the physician decide automatically
• C. Delay decisions until the patient recovers
• D. Overrule patient wishes due to age

Answer: (A)

Determining who has the legal authority to make health care decisions is essential when a patient may not be able to make those decisions themselves. In this scenario, the patient has serious illnesses and a recent stroke, so you first check for who is legally designated to decide, such as a durable power of attorney for health care, an advance directive, or a court-appointed surrogate. If the patient still has decision-making capacity, you involve them and elicit their preferences. If capacity is lacking, you follow the legally recognized surrogate or guardianship process to ensure decisions reflect the patient’s values. Automatically letting the physician decide, delaying decisions, or overruling the patient due to age undermines autonomy and legal rights.