An unresponsive patient is admitted to the intensive care unit following a severe anoxic brain injury. The clinical team determines that the patient completely lacks decision-making capacity. A review of the electronic health record reveals no advance directive, and the patient has never formally designated a durable power of attorney for healthcare. Several individuals who know the patient have arrived at the hospital, each wishing to direct the goals of care. According to the standard legal hierarchy for surrogate decision-makers in most US jurisdictions, arrange the following individuals in the correct order of priority from highest (first in line to make decisions) to lowest (last in line).
- 1The patient's legally married partner
- 2The patient's 28-year-old biological son
- 3The patient's biological mother
- 4The patient's 42-year-old sister
- 5The patient's long-term roommate and close friend
Answer
The correct order of surrogate priority is: legally married partner, adult son, biological mother, sister, and finally the close friend.
In the absence of an advance directive or a designated healthcare proxy, decision-making authority falls to a default surrogate based on standard state statutory hierarchies. This hierarchy reflects who would theoretically be most familiar with the patient's values and wishes. The universally accepted order of priority is: spouse, adult children, parents, adult siblings, and finally other relatives or close friends. Therefore, the legally married partner has the highest priority, followed by the adult son, the mother, the sister, and the close friend.
Step-by-Step Solution
Key Concept
Surrogate Decision-Maker Statutory Hierarchy