Directive

Expect a stem where the patient is incapacitated and has no decision-maker on the chart — the answer is almost always to locate and honor the existing directive first, not to call the family or guess (family becomes the default surrogate only when no directive and no proxy exist). The classic “tell” is a conflict: family demands aggressive treatment while a valid living will refuses it. Here the patient’s own documented wishes guide care, because the directive is their own voice; a clinician who believes overriding it is justified escalates to the provider or ethics committee, not the family. A frequent trap is the DNR patient who codes — the correct action is to honor the order, not start CPR.

Do not confuse the directive (a document) with autonomy (the underlying principle of self-determination) or consent (voluntary agreement for a current, specific procedure, requiring decision-making capacity). The trap is assuming a directive is “active” the moment it’s signed. Memory hook: a living will speaks for you when you cannot.