The Ethical Principle is Autonomy
The correct answer is B) Autonomy - this is the ethical principle that describes a healthcare proxy making decisions as the incapacitated individual would decide for themselves, respecting their self-determination. 1
Understanding Autonomy in Proxy Decision-Making
Autonomy is the foundational ethical principle that recognizes a competent individual's right and capacity to make decisions about their own healthcare. 1 The American Heart Association explicitly defines respect for autonomy as "society's respect for a competent individual's ability to make decisions about his or her own health care," emphasizing that individuals must be able to link their decisions to their values and personal goals of care. 1
Extension of Autonomy Through Proxy Decision-Making
When a patient lacks decision-making capacity, the principle of autonomy extends through surrogate or proxy decision-makers who are expected to make decisions consistent with what the patient would have chosen. 1 The ESPEN guidelines explicitly state that "for persons who cannot exercise their autonomy as they do not have the capacity to consent, there are usually legal representatives to play a decision making role." 1
The proxy's role is fundamentally rooted in preserving the patient's autonomy by attempting to honor what the incapacitated person would have decided for themselves if they were able. 1 This is described as making decisions "as nearly as possible, as what the incapacitated individual would decide for themselves," which directly reflects the principle of autonomy rather than the proxy's own preferences. 1
Why the Other Options Are Incorrect
Veracity refers to truthfulness and honesty in communication, not decision-making authority or self-determination. 1
Beneficence is the obligation to maximize potential benefits and act in the patient's best interest, but it does not specifically address the concept of self-determination or making decisions as the patient would have made them. 1
Justice relates to fairness in the distribution of healthcare resources and equal treatment, not individual self-determination in medical decision-making. 1
Key Clinical Caveat
While autonomy is the principle being honored through proxy decision-making, it's important to recognize that autonomy does not mean patients or proxies have the right to demand any treatment they wish if it is not medically indicated. 1, 2 The principle must be balanced with beneficence and non-maleficence, but the fundamental ethical concept of a person making their own healthcare decisions - or having those decisions made in accordance with their values when incapacitated - is autonomy. 1