An advance directive exists for health care. Which situation would require consulting the surrogate decision-maker?

An advance directive exists for health care. Which situation would require consulting the surrogate decision-maker?

• A. The client with a head injury who has a Glasgow Coma Scale of 13.
• B. The client with COPD who is being weaned from the ventilator.
• C. The client in a hyperglycemic hyperosmolar nonketotic coma.
• D. The client in a hyperbaric chamber for nonhealing leg wounds.

Answer: (A)

The key idea is decision-making capacity and using a surrogate when the patient can’t participate in care decisions. An advance directive guides what to do if the patient can’t speak or understand options, but it only works if someone who knows the patient’s values can interpret and apply it when capacity is lacking. In the head injury case, a Glasgow Coma Scale of 13 means the patient is not fully oriented or capable of reliably understanding or expressing treatment choices. Because the patient cannot communicate or reason about care, a surrogate decision-maker must be consulted to apply the advance directive or substitute judgment to align care with the patient’s preferences. The other scenarios involve situations where the patient is more likely to participate in decisions or where the directive would already guide care without needing a surrogate in that moment, so they don’t flag the surrogate-use need as clearly.

The key idea is decision-making capacity and using a surrogate when the patient can’t participate in care decisions. An advance directive guides what to do if the patient can’t speak or understand options, but it only works if someone who knows the patient’s values can interpret and apply it when capacity is lacking.

In the head injury case, a Glasgow Coma Scale of 13 means the patient is not fully oriented or capable of reliably understanding or expressing treatment choices. Because the patient cannot communicate or reason about care, a surrogate decision-maker must be consulted to apply the advance directive or substitute judgment to align care with the patient’s preferences.

The other scenarios involve situations where the patient is more likely to participate in decisions or where the directive would already guide care without needing a surrogate in that moment, so they don’t flag the surrogate-use need as clearly.