• Patient selection
  • Inability to communicate wishes regarding medical decision-making
  • Advance directive not available or applicable
  • No previously designated surrogate decision maker
• Surrogate selection
  • Priority to patient’s spouse
  • Alternate: adult children, parents, adult siblings, other family members
• Implementation
  • Substituted judgment: what the patient, not family, would have wanted
  • Decisions in the patient’s best interest