fundamentals
Default Surrogate Decision Making
Legal Standard for Making Medical Decisions
As much as possible, the surrogate decision maker should include the person they are assisting in the decision-making process. All surrogate decision makers, whether appointed by the person, by the court, or by default, have an obligation to follow the expressed wishes of the adult person and take into account the person’s values if known. Health care professionals are responsible for honoring these wishes and values as well. If the person’s wishes and values are not known, the surrogate decision maker must always be guided by the best interests of the person. Health care professionals are not required to provide treatments that are medically inappropriate, such as those that are against generally accepted health care standards. If a particular treatment is against a clinician’s conscience but is still within generally accepted health care standards, the clinician should try (and in most states is legally obligated to try) to transfer a person to another doctor or institution willing to comply. As a practical matter, the first step in making a treatment decision as a person's agent or surrogate decision maker is to get all the facts from health care professionals about diagnosis, prognosis, and alternative treatments. When facing a critical treatment decision, agents and surrogate decision makers should ask themselves questions such as the following: Will this treatment or test make a difference? How? Do the burdens or harms of this treatment outweigh the benefits? Is there hope of recovery, and, if so, what will life be like afterwards? What is the goal of this treatment? Is it aligned with the patient's goals? 