fundamentals
Default Surrogate Decision Making
Adults
In most states, the default surrogate decision maker for adults is normally the next of kin, specified in a priority order by state statute, typically starting with the person’s spouse or domestic partner, then an adult child, a parent, a sibling, and then possibly other relatives. A growing number of states also authorize a close friend to act as default surrogate. If more than one person has the same priority (such as several adult children), consensus is preferred, but some states allow health care professionals to rely on a majority decision or to request that one person be selected to decide for the group. Doctors are more likely to accept the judgment of a person who understands the person’s medical situation and seems to have the best interest of the person in mind. Conflict among authorized decision-makers seriously hinders the process. People with no family or close friends who are alone in the hospital are far more likely to receive a court-appointed guardian or conservator. If it is not clear who should make decisions, doctors may need to consult with hospital ethics boards or lawyers. In states with no default surrogate laws, health care professionals still normally rely on the person's close family members to make decisions, but may find that legal uncertainties or family disagreement may create barriers to treatment. 