When an advance directive is not available, who should be the substitute decision maker (SDM) for the patient?

When an advance directive is not available, who should be the substitute decision maker (SDM) for the patient?

• A. Mr. Morrissey's former spouse
• B. Mr. Morrissey's eldest son
• C. Mr. Morrissey's adult children
• D. Mr. Morrissey's sister

Answer: (C)

When someone can’t make their own medical decisions and there’s no advance directive, the person who acts as substitute decision maker is chosen from the closest family members in a standard order. The first in line is the spouse or adult partner. If there isn’t one, the next group is adult children, who are the most likely to know the patient’s values and wishes. An ex-spouse isn’t typically eligible in this situation, and choosing just one elder son doesn’t reflect the common hierarchy or the involvement of all adult children. A sister is a sibling but would come after adult children in the default order. So adult children are the appropriate choice because they are the next in line for representing the patient’s preferences when there’s no directive.

When someone can’t make their own medical decisions and there’s no advance directive, the person who acts as substitute decision maker is chosen from the closest family members in a standard order. The first in line is the spouse or adult partner. If there isn’t one, the next group is adult children, who are the most likely to know the patient’s values and wishes. An ex-spouse isn’t typically eligible in this situation, and choosing just one elder son doesn’t reflect the common hierarchy or the involvement of all adult children. A sister is a sibling but would come after adult children in the default order. So adult children are the appropriate choice because they are the next in line for representing the patient’s preferences when there’s no directive.