In this lecture, we're going to talk
about surrogate decision makers.
There are going to be times when the patient is
not able to participate in the informed consent process
and we're going to need to find a person to speak on
their behalf, what we call a surrogate decision maker.
So, this is an individual with decision-making
capacity that has the authority to make decisions
about medical treatments on behalf of that incapacitated
patient when they need medical treatment.
So, this is hopefully, a person that's best able to represent
the patient in the decision-making process.
So, who gets chosen as a surrogate decision maker
is going to be dependent on jurisdiction.
So, I will refer you to your own legal
requirements in your locality to figure out
who the appropriate surrogate
decision maker would be.
Typically, there's going to be an ordering
or a priority as to who you select as this decision maker.
I'm going to give
you a typical ordering.
The idea here is that if you go to the first person
on the list and they're not available
or they don't exist, then, you go to
the next person on the list.
That doesn't exist. You go to the
next person on the list and so on.
So, typically, at the top of the list would be a healthcare
proxy or durable power of attorney for healthcare.
As you heard about in the
advanced care planning lecture,
this is a person named by the patient to speak
on their behalf when they lose capacity.
So, we're clear, we know that this is the patient,
this is who they wanted to speak for them.
So, this healthcare proxy would be
at the top of the list.
When there is no healthcare proxy,
the patient hasn't completed an advanced directive,
hasn't participated in any kind of advanced
care planning discussion previously,
then, the usual ordering would be you'd go to
a family member to be a surrogate decision maker.
That would be, for instance,
the patient's spouse.
If the spouse doesn't exist,
then, it might be the adult child.
If there are multiple adult children,
all would have equal decision-making.
And then, it might be, well, if there are no children,
then, you go next on the list to a parent.
Then, next on the list to an adult sibling,
maybe another relative or another friend.
You just keep working down
the list until you find a person
that can serve the role
as a surrogate decision maker.
One caveat to this is that there may be times when a patient
has either never had capacity to make any kind of decision,
not just healthcare decisions but all decisions
or they were able to make, you know, certain decision.
And then, permanently lost that ability
to make decisions and the court steps in
to then appoint a guardian
to speak for them.
If there is a court-appointed guardian,
often, they're going to be on higher priority list
than these other
So, you have to again, check your own
jurisdiction about this list
and how you'd figure out who the
appropriate surrogate decision maker is.