The surrogate is responsible to act in accordance with the values and pref erences of the patient. If the patient's preferences vis-a-vis the choice at hand have been clearly defined in an AD such as a living will, this task if the dieasier. However, rective is unclear, or if no exists, he surrogate is required to decide in accordance with what he or she believes the individual would have chosen. This is referred to as the substituted judgment Admittedly, no clear line exists between autonomous and surrogate decision making, and the process, in practice, may more accurately resemble a shared decision making model However, even in shared decision making, where input from physicians and family memuded, the goal at a decision that is patient centered. Unfortunately, many individuals who are called on to act as deci surrogates do not understand this principle and believe are being asked to make the decision base on their own wishes or Not only does this put increased burden on the surrogate it undermines patient autonomy. Formalized processes surrogates about their role in the decisionmaking process can help reinforce patient autonomy.