Who may serve as a patient’s surrogate decision-maker and what determines surrogate authority?

• A. Surrogates can be chosen by anyone.
• B. Legally appointed durable power of attorney for health care, a court-appointed guardian, or close family member if no directive; authority determined by state law and patient wishes.
• C. Only physicians can act as surrogates.
• D. Surrogate authority is determined by hospital policy only.

Answer: (B)

Surrogate decision-making hinges on honoring the patient’s autonomy and the legal mechanisms that designate who can decide. A surrogate is typically named in a durable power of attorney for health care or appointed by a court as a guardian. If there’s no such designation, many jurisdictions follow a statutory order of priority—usually a spouse, then adult children, parents, and siblings, among others—for who may act as a surrogate; some decisions may rely on the patient’s previously stated wishes in advance directives. The authority comes from state law and the patient’s expressed preferences, not from hospital policy alone, and lasts while the patient lacks capacity; it ends when capacity is regained or the patient dies. This framework ensures decisions reflect the patient’s values and protects against arbitrary acts.