A 45-year-old unhoused man is admitted to the neurointensive care unit following a severe traumatic brain injury. He is intubated, deeply comatose, and lacks decisional capacity. No advance directives, living wills, or designated healthcare proxies are on file. The clinical team concludes that neurological recovery is highly unlikely and recommends transitioning to comfort-focused care. The hospital social worker identifies several individuals connected to the patient. Assuming no court-appointed legal guardian exists, arrange the following individuals in the legally preferred hierarchical order to serve as the default surrogate decision-maker, from highest priority to lowest priority.
- 1The patient's legally married but estranged wife
- 2The patient's 22-year-old biological daughter
- 3The patient's 68-year-old biological mother
- 4The patient's 48-year-old brother
- 5A close friend who directs the local homeless shelter
Answer
The correct legal hierarchy is: Estranged wife, followed by the adult daughter, mother, brother, and finally the close friend.
In the absence of a designated healthcare proxy (Medical Power of Attorney) or a court-appointed guardian, most US states follow a uniform statutory hierarchy for medical decision-making. This hierarchy generally prioritizes the spouse first, followed by adult children, parents, adult siblings, and finally close friends. A legally married spouse retains priority even if the couple is estranged, provided there is no formal divorce or legal separation decree.
Step-by-Step Solution
Key Concept
Statutory Default Surrogate Decision-Maker Hierarchy
Estimated Time:1m 0s