Surrogate Decision-maker

A surrogate decision-maker is a person authorized to make health care decisions on behalf of another individual who is unable to make those decisions themselves due to incapacity or loss of decision-making capacity (DMC). This role is crucial when a patient cannot communicate or understand medical information to make informed choices about their treatment.

Key points about surrogate decision-makers include:

• They may be chosen by the patient in advance through legal documents like a health care power of attorney or advance directive, or they may be assigned by law based on a priority order of family members or close friends if no prior designation exists.
• The typical priority order for default surrogates in many states starts with the spouse or domestic partner, followed by adult children, parents, siblings, and sometimes close friends.
• The surrogate must make decisions based on the patient's known wishes and values (called "substituted judgment") whenever possible. If the patient's preferences are unknown, decisions should be made based on the patient's best interests.
• Surrogates are ethically and legally obligated to advocate for what the patient would want, not their own preferences.
• Health care providers must certify that the patient lacks capacity before a surrogate can make decisions, and surrogates should consider the patient's medical condition, prognosis, previously expressed wishes, and personal beliefs when deciding.
• If there is disagreement among multiple surrogates or uncertainty about who should act, health care professionals may consult ethics boards or legal authorities.

In summary, a surrogate decision-maker acts as a legally and ethically recognized advocate who makes medical decisions for an incapacitated patient, aiming to honor the patient's values and best interests.