Abstract

In this issue of the Southern Medical Journal, Hunter and Walters report an ongoing problem with surrogate decision making in the absence of legally sufficient advance directives: the default choice as defined by state law may not be the patient’s preferred surrogate.¹ This mismatch is particularly important because so few hospitalized patients (in this case, fewer than one-third) complete advance directives. Although the nature and weight of a surrogate’s decision have been the subject of recent debate,² the need for someone to express the wishes of an incapacitated patient is deeply rooted in contemporary understandings of medical ethics.