An 88-year-old married man is admitted following a cardiac arrest at home.

In discussions about end-of-life care, it is critical to shift the focus from the substitute decision-maker’s own feelings to what the patient would have wanted. This approach promotes ethically sound and patient-centered decisions. It is respectful, supportive, and maintains trust.

Toronto Notes 2023 – ELOM, “Advance Care Planning and End-of-Life Decisions”:

“When a patient cannot express wishes, decisions must be based on known prior wishes or substituted judgment—what the patient would have wanted.”

MCCQE1 Objectives (ELOM > 90-2: Capacity, Consent, and End-of-Life Care):

“Candidates must guide surrogate decision-makers toward reflecting on the patient’s values and previously expressed wishes.”

Options A and B are inappropriate—waiting without engagement or unilateral withdrawal is unethical. C does not address the wife’s emotional or ethical concerns. E is premature unless the wife is clearly unable or unfit to act as decision-maker.

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