Who may serve as a surrogate decision-maker when a resident lacks capacity to consent?

• A. A legally authorized representative such as a durable power of attorney for health care, a court-appointed guardian, or a health care proxy per state law
• B. A family member chosen by the resident's neighbor
• C. Any staff member can decide
• D. Only a court-appointed guardian can decide

Answer: (A)

When a resident can’t understand or appreciate the nature of health care decisions, someone must be legally authorized to decide for them. That authorization comes from state law and can be established in advance or by a court. The people who may serve as a surrogate are typically a legally designated representative such as a durable power of attorney for health care (health care proxy), or a court-appointed guardian. These roles exist specifically to protect the resident’s wishes and best interests, and they step in only because there is no capacity to consent.

A neighbor’s choice of a family member or any staff member does not have automatic legal authority to decide; they would need to be the legally appointed surrogate. The key point is that surrogate decision-making relies on formal designation, not informal agreement. If the resident has an advance directive or known wishes, the surrogate should follow those. If not, the surrogate makes decisions in the resident’s best interests, guided by substituted judgment when possible.