Geriatric Quick Consult      Decision-making Capacity      Do #9

When patients are incapacitated, contact the appropriate surrogate decision-maker(s)

Knowledge

Action

In Virginia, the hierarchy of surrogate decision-makers is specified in law as part of the Natural Death Act (INSERT REFERENCE: TEXT OF THIS LAW). The hierarchy (in 2002) is as follows: Power of Attorney, documented Legal guardian Spouse Children Parents Siblings Other living relatives Physician Only after a reasonable effort has been made to contact an appropriate surrogate decision-maker is the physician allowed in emergent situations to act on the patient's behalf. Even when there are no available qualified decision-makers, the physician may not proceed independently with non-emergent procedures, but must ask permission from a judge. When there are differences of opinion among the decision-makers, such as when there are several children that do not agree with one another, it is best to have a family meeting and attempt to achieve consensus.

In Virginia, follow the hierarchy of surrogate decision makers about patient treatment. Only in emergent situations, when unable to contact an appropriate surrogate, can you act on the patient's behalf. In non-emergent situations, when unable to contact an appropriate surrogate, you must seek a judge's permission.