A surrogate is a person who is personally or legally designated to make healthcare decisions on behalf of another person who is no longer capable of making healthcare decisions for himself/herself.

It is important to appoint a surrogate as there are hosts of medical conditions, treatments or procedures that may arise when a patient becomes incompetent or incapacitated. Even if an advance directive is available, it is frequently written in general terms.  The living will, in general, provides only a blueprint of the person’s preferences/wishes at end-of-life care, signifying whether life-sustaining treatments will be sought. It is not possible to cover all aspects and specifics of care or interventions in the living will. 

The surrogate would ideally decide based on his/her knowledge of the patient’s values and beliefs. The Ethical and Religious Directives reiterates that surrogates should make decisions that are in line with the Catholic moral principles and to the person’s intentions and values or to the person’s best interests if intentions are unknown.[1]

The surrogate would act as the patient would act if he/she is competent to choose even if what the patient has requested is not what the surrogate would choose for himself. This is called the substituted judgment standard.[2] When the surrogate is not sure what the patient would want, he/she should follow the “best interests” standard on the patient’s behalf. The best interest standard considers the entire physical, moral, emotional and spiritual good of the patient.[3]

A healthcare surrogate should be familiar with the principal’s values, principles, and beliefs.

It is important to identify a healthcare surrogate, who is familiar with the patient and who has the moral and legal authority to address or interpret vague issues not specified in the declaration of the living will.

The age and maturity of the designated surrogate must be considered.

The principal must appoint a surrogate with care. They must truly know each other and must have shared a significant amount of time to be able to identify the values preferences and wishes s of age or older and should be accessible, at least by a phone call. It is important that the principal must choose a person of character and maturity as a surrogate since he/she might be going to make a difficult decision on the principal’s behalf.

Appoint only one surrogate.

There should only be one surrogate to avoid conflict. An alternate surrogate needs to be identified in an event that the primary may no longer be capable to discharge surrogate duties.[4]

Surrogates cannot act whatever they wanted for the patient.

 A healthcare surrogate does not have a blank check to decide whatever he/she wants for the patient. Those who provide care have legal as well as moral responsibilities to follow the patient’s advance directives unless there is a convincing proof that a certain preference or request may not serve the patient’s interest, or when it violates the rights of others.  The Hasting’s Center clarifies that attending healthcare professionals may seek ethics consultation when in doubt about a surrogate’s decision: 

If the responsible professional has concerns about the ability of a surrogate to make treatment decisions in keeping with the standards for surrogate decision-making, the professional may seek an ethics consultation to determine whether the surrogate understands the obligations of surrogate decision making and can discharge them. On occasion, judicial review may be necessary.[5]

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[1] USCCB, Ethical and Religious Directives, No. 25.

[2] Matthew P. Lomanno, ”Healthcare Proxy and Advance Directives,” in Catholic Healthcare Ethics: A Manual for Practitioners, 216.

[3] Matthew Lomanno, “Healthcare Proxies and Advance Directives,” 216.

[4] Virginia Catholic Conference, Catholic Advance Medical Directive,5.

[5]  Berlinger, Jennings and Wolf, The Hastings Center Guidelines, 64.