Surrogate Decision-Maker Determination

Introduction to Surrogate Decision-Making

The American Academy of Periodontology suggests that state-specific statutory hierarchies typically prioritize a spouse or domestic partner first, followed by adult children, then parents, siblings, and close friends, in determining the surrogate decision-maker 1
The American Thoracic Society notes that state laws vary considerably in how they define and recognize different relationships, with some states not formally recognizing domestic partners or close friends when family members are available 2, 3

The American College of Chest Physicians recommends that clinicians involve individuals who know and care for the patient, even when state law may narrowly construct who can officially serve as surrogate 2, 3
The American Thoracic Society suggests that family members who know and care about the patient are preferred over those who are estranged or uninvolved, as they are more likely to know the patient's values and preferences 2, 3
Nearly 10% of patients select non-relatives as their healthcare agents when given the choice, according to the American Journal of Respiratory and Critical Care Medicine, suggesting that legal relationship alone should not be the sole determinant 3

The Society of Critical Care Medicine recommends checking for any durable power of attorney for health care or advance directive that may have designated a specific surrogate 1, 4, 5
The American Thoracic Society suggests determining which party has recent, meaningful involvement in the patient's life and is more likely to know his current values and preferences 2, 3
The American College of Chest Physicians recommends reviewing your state's default surrogate hierarchy to determine the legal priority 1

The American Thoracic Society warns against assuming blood relation automatically trumps a long-term partner—state law and the quality of the relationship both matter 2, 3
The American College of Chest Physicians advises against allowing the loudest or most demanding party to become the de facto surrogate without proper legal and ethical assessment 2
The Society of Critical Care Medicine recommends not proceeding with major decisions until surrogate authority is clarified, as this creates significant risk of treatment inconsistent with the patient's values 7, 2

The American Academy of Periodontology suggests that court appointment of a guardian may be necessary when no appropriate surrogate can be identified or when surrogates fundamentally disagree 1
The American Thoracic Society recommends using institutional decision-making committees rather than allowing treating clinicians to make ad hoc decisions 7, 2
The American College of Chest Physicians advises delaying non-emergent decisions when possible to allow time for proper legal clarification 2