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Difficulty: EasyInformed Consent and Refusal of Care

A 65-year-old man is brought to the emergency department unconscious following an ischemic stroke. He requires urgent medical intervention. The patient lacks decision-making capacity and has no written advance directive or formally designated healthcare proxy. Several family members arrive at the hospital and all want to participate in his care decisions. According to standard legal precedence in the United States, arrange the following family members in the correct hierarchy of priority to act as the surrogate decision-maker, from highest priority (first) to lowest priority (last).

  1. 1The patient's wife
  2. 2The patient's 30-year-old daughter
  3. 3The patient's 85-year-old father
  4. 4The patient's 60-year-old brother

Answer

The correct order of surrogate decision-maker priority is: Wife (Spouse), 30-year-old daughter (Adult Child), 85-year-old father (Parent), and 60-year-old brother (Adult Sibling).
In the absence of an advance directive or designated healthcare proxy, substitute decision-making falls to a surrogate according to a standard legal hierarchy. The universally accepted standard sequence in the United States is: Spouse, followed by Adult Children, then Parents, and finally Adult Siblings. Therefore, the wife has first priority, the 30-year-old daughter is second, the 85-year-old father is third, and the 60-year-old brother is fourth.

Step-by-Step Solution

1
Determine if the patient has capacity or a designated proxy.
The patient lacks capacity and has no advance directive or designated proxy.
This triggers the need for a default statutory surrogate decision-maker.
2
Recall the standard statutory hierarchy for surrogate decision-makers.
The standard hierarchy is: 1. Spouse, 2. Adult Children, 3. Parents, 4. Adult Siblings, 5. Other relatives.
This legal hierarchy exists to prevent conflicts and ensure decisions are made by those presumed closest to the patient.
3
Match the family members provided in the scenario to the established hierarchy.
Wife = 1, Daughter = 2, Father = 3, Brother = 4.
Applying the concept to the specific options yields the correct sequence.

Key Concept

Statutory surrogate decision-maker hierarchy
Estimated Time:1m 0s
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Topics

Informed Consent and Refusal of Care

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