Introduction to Surrogate Decision Making

by Mark Hughes, MD, MA

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    00:01 In this lecture, we're going to talk about surrogate decision makers.

    00:05 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.

    00:16 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.

    00:30 So, this is hopefully, a person that's best able to represent the patient in the decision-making process.

    00:36 So, who gets chosen as a surrogate decision maker is going to be dependent on jurisdiction.

    00:41 So, I will refer you to your own legal requirements in your locality to figure out who the appropriate surrogate decision maker would be.

    00:49 Typically, there's going to be an ordering or a priority as to who you select as this decision maker.

    00:56 I'm going to give you a typical ordering.

    00:58 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.

    01:07 That doesn't exist. You go to the next person on the list and so on.

    01:12 So, typically, at the top of the list would be a healthcare proxy or durable power of attorney for healthcare.

    01:18 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.

    01:27 So, we're clear, we know that this is the patient, this is who they wanted to speak for them.

    01:34 So, this healthcare proxy would be at the top of the list.

    01:38 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.

    01:53 That would be, for instance, the patient's spouse.

    01:56 If the spouse doesn't exist, then, it might be the adult child.

    02:00 If there are multiple adult children, all would have equal decision-making.

    02:04 And then, it might be, well, if there are no children, then, you go next on the list to a parent.

    02:09 Then, next on the list to an adult sibling, maybe another relative or another friend.

    02:15 You just keep working down the list until you find a person that can serve the role as a surrogate decision maker.

    02:22 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.

    02:37 And then, permanently lost that ability to make decisions and the court steps in to then appoint a guardian to speak for them.

    02:45 If there is a court-appointed guardian, often, they're going to be on higher priority list than these other family relationships.

    02:54 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.

    About the Lecture

    The lecture Introduction to Surrogate Decision Making by Mark Hughes, MD, MA is from the course Surrogate Decision Making and Family Meetings.

    Included Quiz Questions

    1. Healthcare proxy
    2. Sister
    3. Mother
    4. Grandmother
    5. Best friend
    1. Court-appointed guardian
    2. Spouse
    3. Adult child
    4. Parent
    5. Close friend

    Author of lecture Introduction to Surrogate Decision Making

     Mark Hughes, MD, MA

    Mark Hughes, MD, MA

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