A 45-year-old man is brought to the emergency department after a severe motor vehicle collision. He is intubated, comatose, and lacks decision-making capacity. The trauma surgery team determines he requires an emergent decompressive craniectomy for a rapidly expanding epidural hematoma. The patient has no written advance directives and has not legally designated a healthcare proxy. Several family members arrive at the hospital and express differing opinions on whether to proceed with the surgery. According to the standard legal hierarchy of surrogate decision-makers, arrange the following family members in order of their priority to make medical decisions on behalf of the patient, from highest priority (first) to lowest priority (last).
- 1The patient's legally married wife
- 2The patient's 22-year-old son
- 3The patient's mother
- 4The patient's 38-year-old sister
Answer
The correct sequence of surrogate decision-makers is: legally married wife, 22-year-old son, mother, and finally the 38-year-old sister.
In cases where an adult patient lacks decision-making capacity and has not designated a healthcare proxy, a default surrogate decision-maker is identified based on a standard legal hierarchy. While minor state-to-state variations exist, the generally accepted order tested on the USMLE is: 1) Spouse, 2) Adult children, 3) Parents, 4) Adult siblings, and 5) Other relatives. Therefore, the legally married wife is first, followed by the adult son, then the mother, and finally the adult sister.
Step-by-Step Solution
Key Concept
Standard legal hierarchy of surrogate decision-makers
Estimated Time:1m 0s