Governance









White Paper on Surrogate Decision-Making and Advance Care Planning in Long-Term Care

Table of Contents
  1. Introduction
  2. Competence
  3. Decision-Making Capacity
  4. A framework for assessing decision-making capacity
  5. Surrogate Decision-Making
  6. Advance Directives
  7. Guardianship
  8. An Ethical Framework for Surrogate Decision-Making
  9. Decision-making by mentally incapacitated long-term care facility residents
  10. The hierarchy of medical decision-making for incapacitated nursing home residents
  11. Guidance for guardians and other surrogates about medical decision-making
  12. What surrogates and health care provider should expect from each other
  13. Some Important Clinical Issues
  14. Summary and Conclusions
  15. References

Surrogate Decision-Making

A surrogate, one who makes decisions on behalf of another who is unable to make decisions for him- or herself, can be designated either informally or formally. State laws and terminology regarding surrogates, also called proxies or health care agents, and the scope of responsibilities and powers accorded to them, vary widely. Providers and surrogates working with incapacitated people should become familiar with their state's relevant laws and provisions.

In the most formal situations, surrogates are court-appointed; they are usually termed guardians or, in some states, conservators. Other formally designated surrogates, whose appointment does not require action by the courts, are those who have been named in advance directives prepared by the incapacitated person before becoming incapacitated. In situations in which there has been no court decision and when advance directives have not been specified, state laws may codify the order or hierarchy of people upon whom responsibility for surrogate decision-making devolves, usually family members or close friends of the incapacitated person; these surrogates are not court-appointed and are thus considered informal.
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