Many residents of nursing facilities and other long-term care settings are cognitively impaired and thus may be incapable of making decisions about their medical care. Clinicians providing care for these residents must rely on previously specified advance directives or on other designated decision-makers, usually called surrogates, for guidance in medical decision-making. Because advance directives can explicitly address only a limited number of situations, and because for each incapacitated patient there are usually many decisions to make over time, continuing communication between the medical providers and surrogates is often necessary. Understanding the nature of advance care planning and surrogate decision-making is thus crucial for both healthcare providers and surrogates.
The terminology and laws pertaining to all aspects of surrogate decision-making vary greatly from state to state, and people involved in such decision-making must become familiar with their own state's statutes and language. What follows here is a general guide to surrogate decision-making, including that by guardians, and to the principles underlying it, along with recommendations on the subject from the American Medical Directors Association (AMDA). It is an overview of the subject, written with the understanding that some of the words used below may not be exactly those used in any individual's state of residence.