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Difficulty: HardAdvance Directives and Surrogate Decision Making

A 38-year-old woman is admitted to the intensive care unit and placed on mechanical ventilation following a severe eclamptic seizure and subsequent intracranial hemorrhage. She is deeply comatose, unresponsive to stimuli, and determined to lack decision-making capacity. A review of her records confirms she has no written advance directive and has not designated a healthcare proxy. The multidisciplinary team determines that a tracheostomy and percutaneous endoscopic gastrostomy (PEG) tube are medically indicated for long-term management, and they must identify the appropriate legal surrogate to provide informed consent. According to the standard consensus model (Uniform Health-Care Decisions Act), arrange the following family members in the correct statutory order of priority to serve as the surrogate decision-maker, from highest priority (first) to lowest priority (last).

  1. 1The patient's legally married husband
  2. 2The patient's 18-year-old legally adopted son
  3. 3The patient's 65-year-old biological mother
  4. 4The patient's 35-year-old maternal half-sister
  5. 5The patient's 28-year-old nephew

Answer

The correct sequence of priority is: Husband, 18-year-old adopted son, Biological mother, Maternal half-sister, Nephew.
In the absence of an advance directive or designated healthcare proxy, the Uniform Health-Care Decisions Act provides a standard priority list for surrogate decision-makers. The hierarchy prioritizes the legal spouse first, followed by adult children, parents, adult siblings, and finally other adult relatives or close friends. Importantly, an 18-year-old is considered an adult child, and legally adopted children have identical rights to biological children. Furthermore, half-siblings are legally classified alongside full siblings, granting them priority over extended relatives such as a nephew.

Step-by-Step Solution

1
Determine the necessity of a surrogate and verify the absence of appointed proxies.
The patient lacks capacity and has no durable power of attorney for healthcare.
Statutory default surrogacy laws apply only when the patient cannot decide and has not appointed someone else.
2
Apply the standard statutory surrogate hierarchy.
The hierarchy generally follows: Spouse > Adult Child > Parent > Adult Sibling > Other Relatives/Close Friends.
The Uniform Health-Care Decisions Act provides this standard priority list across most United States jurisdictions.
3
Evaluate the specific legal relationships of the provided family members.
Adopted children have the exact same rights as biological children, an 18-year-old is an adult, and half-siblings share the sibling priority level.
Understanding legal definitions of relatives prevents incorrectly bypassing individuals with higher statutory priority.

Key Concept

Statutory Surrogate Decision-Making Hierarchy
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Topics

Advance Directives and Surrogate Decision Making

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