Decision Making Hierarchy
From Policy 4.17:
The surrogate should be chosen by identifying the individual highest in priority from the list below:
- Legal guardian, unless a court has limited the guardian's powers (review court order).
- Health care agent named in the patient’s Health Care Power of Attorney (POA). Usually the appointment of a guardian ends the authority of the POA (review guardianship court order to determine any restrictions on the POA).
- If there is no guardian or POA, a surrogate expressly designated by the patient (verbally or in writing) before the patient lost decision making capacity. The patient’s wishes should be documented in the medical record;
- Spouse or domestic partner. For purposes of this policy, domestic partner means a registered domestic partner or an individual who would qualify to register as a domestic partner under Wisconsin law (i.e., an adult who is not married or in another domestic partnership, shares a residence with the patient, is unrelated to the patient and is the same-sex as the patient). Individuals who do not fit within this definition may be considered as a possible surrogate using the categories for “Others” or “Exceptions” below. If the patient and the spouse/domestic partner are separated, the legal department should be consulted to determine whether the spouse/domestic partner should still be considered able to serve.
- Adult child of the patient.
- Parents of the patient.
- Adult siblings of the patient.
- Others. When there is no one of higher priority able or willing to serve (i.e., no guardian, POA, spouse/domestic partner, adult child, parent or adult sibling), another close relative or friend may act as the surrogate.
- Exceptions. In consultation with the Hospital Attorney, exceptions to the above priority may be authorized in unusual cases.
- Questions or Disputes. Patient Relations or, if unavailable, Hospital Attorney is available for consultation when determining whether an individual is an appropriate surrogate. If the proposed surrogate has not been living with or actively involved in the care of the patient recently or there are others involved in the patient's care who object to the selection, such consultation should occur. Consultation with the Hospital Attorney is encouraged when providers are unable to resolve disputes concerning the designation of a surrogate.