For patients who lose capacity and have no legally appointed surrogate decision maker, most states have laws that specify a hierarchy of persons who may serve as surrogate decision makers by default. But these state "default surrogate consent statutes" vary in their recognition of important relationships beyond the nuclear family, such as friends, more distant relatives, and intimate relationships outside marriage.
A research study just published in JAMA shows substantial number of patients (>7% of the >100,000 patient sample) had a next-of-kin relationship outside the nuclear family.
The authors recommend that states consider adopting uniform default consent statutes broad and inclusive to reflect the evolving social ties in the United States. In the meantime, it is important for individuals to complete advance directives to opt out of the default surrogate rules and select the people whom they trust and who know them best.
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