In the event that an incompetent individual has an advance directive regarding artificial nutrition and hydration, how should the decision be made using ethical principles?

In the event that an incompetent individual has an advance directive regarding artificial nutrition and hydration, how should the decision be made using ethical principles?

• A. Beneficence should guide the decision.
• B. Justice should guide the decision.
• C. Nonmaleficence should guide the decision.
• D. Autonomy should guide the decision.

Answer: (D)

Respect for autonomy guides decisions when an incompetent patient has an advance directive. An advance directive is the patient’s own expressed wishes about medical care, including artificial nutrition and hydration, to be followed if they cannot participate in decisions. When such a directive exists, clinicians and surrogates are obligated to honor those stated preferences, because doing so respects the patient’s right to self-determination and to determine what happens to their body. Beneficence and nonmaleficence remain important, but they operate through the lens of the patient’s previously stated wishes. If the directive clearly indicates a choice about nutrition and hydration, that choice should guide care even if it might seem to conflict with what clinicians might consider immediately beneficial or least harmful. Justice concerns about fair allocation of resources may be relevant in broader policy contexts, but the immediate individual decision should follow the patient’s autonomy as expressed in the directive.

Respect for autonomy guides decisions when an incompetent patient has an advance directive. An advance directive is the patient’s own expressed wishes about medical care, including artificial nutrition and hydration, to be followed if they cannot participate in decisions. When such a directive exists, clinicians and surrogates are obligated to honor those stated preferences, because doing so respects the patient’s right to self-determination and to determine what happens to their body.

Beneficence and nonmaleficence remain important, but they operate through the lens of the patient’s previously stated wishes. If the directive clearly indicates a choice about nutrition and hydration, that choice should guide care even if it might seem to conflict with what clinicians might consider immediately beneficial or least harmful. Justice concerns about fair allocation of resources may be relevant in broader policy contexts, but the immediate individual decision should follow the patient’s autonomy as expressed in the directive.