Geriatric Quick Consult      PEG Tube Decisions      Do #3

Review advance directives.

Knowledge Action
If the patient has advance directives stating that they do not wish to be tube fed, or has communicated this to the family at a time when they were competent, the family should be encouraged to follow the patient's wishes.

Unfortunately, many patients have never discussed their preferences with regard to tube feeding and family members have to make the decision for them.

In Virginia law, a properly executed Power of Attorney supercedes all other surrogates.

If there are written advance directives and a Power of Attorney has been completed, these are binding and must be followed.

If no advance planning has been done, the hierarchy of decision-maker is as follows:
  • Power of Attorney
  • Guardian, court-appointed
  • Spouse
  • Majority of adult children
  • Parents
  • Majority of siblings
  • Other blood relatives
  • Physician, after reasonable efforts are made to locate all others listed above
  • Encourage family to follow patient's wishes.


  • Follow hierarchy of decision-maker.
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