In a scenario where a client lacks decision-making capacity but has an authorized decision-maker, how should informed consent be addressed?

• A. The CHW may obtain consent directly from the client after explaining benefits, risks, and alternatives.
• B. Respect the client's autonomy, work with authorized decision-makers, and support but not obtain medical consent; seek proper authorization.
• C. Consent is not needed if there is a guardian.
• D. CHWs should decide what is best for the client without consent.

Answer: (B)

The situation tests how informed consent works when a client cannot make medical decisions but has someone legally authorized to decide for them. In this scenario, the CHW should honor the client’s values and prior wishes, involve the person or entity empowered to make decisions, and ensure formal authorization is in place before any medical consent is obtained.

This is why the best approach is to respect the client’s autonomy by engaging the authorized decision-maker and providing support, not by obtaining medical consent directly from the client. The CHW helps the surrogate understand the benefits, risks, and alternatives, ensures the decision aligns with the client’s preferences, and confirms that the proper authorization is on file. This protects the client’s rights while ensuring that consent comes from the person legally able to provide it.

Directly obtaining consent from the client isn’t appropriate when they lack decision-making capacity, and a guardian or other surrogate should deliver consent rather than the CHW making the decision unilaterally. The CHW also doesn’t decide what’s best for the client without consent; medical decisions require the surrogate’s authorization or the clinician’s fulfillment of the consent process.