Patients without an advance directive or power of attorney have long been able to designate a surrogate, even if it's simply by verbally declaring so while at the hospital but that relies upon the patient being conscious. Under the hierarchy scheme for decision-making, members of the patients family fall within a priority list of potential surrogates who may act as surrogate. Erica Wood is the Assistant Director of the ABA Commission on Law and Aging in Washington, DC. If an agent has been named, that person would make all subsequent decisions. If not, the Order of Decision Makers for Ohio and Florida, according to the law, are: For Florida only, not Ohio: A close friend who has exhibited special care and concern for you and who is familiar with your activities, health, and religious or moral beliefs can also be used if no one from the above list is available. We also recommend you to review and revise your document as necessary: Advance Directive documents in multiple languages can be found at the following link: Ohio Advance Directives forms in English: If you are physically at one of our locations, you can also request the forms from any Registration, Care Management or Spiritual Care department. Two-sided printing is optional. All surrogate decision makers, whether appointed by the person, by the court, or by default, have an obligation to follow the expressed wishes of the adult person and take into account the persons values if known. KFF is an endowed nonprofit organization providing information on health issues to the nation. "With the next-of-kin list, often the person who brought the patient in is a family member or close friend with a clear understanding of the patient's wishes. To avoid next of kin confusion, it is always best when a next of kin can be formally named ahead of time. However, 27% of Americans say they have thought very little about how they would like medical professionals to handle end-of-life medical decisions. Methods: Comments are moderated before they are published. Power of attorney supersedes next of kin. By David J. Pierson, MD, Editor, Professor, Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle, is Editor for Critical Care Alert.. Synopsis: In this study of patients admitted to the medical ICU in a metropolitan West Coast hospital, 16% of them lacked decision . In states with no default surrogate laws, health care practitioners still normally rely on the person's close family members to make decisions but practitioners may find that legal uncertainties or family disagreement may create barriers to treatment. There are two primary types of Advance Directives in the state of Ohio, (1) Health Care Power of Attorney and (2) Living Will. Desired and perceived participation in medical decision-making in patients with haemato-oncological diseases. How to comfort the family of the deceased? Careers. MeSH Lois Richardson, a vice president and legal counsel for the hospital association, said a strict order of surrogates often doesn't reflect what a patient would want. Another way to avoid complications is to appoint a legal power of attorney. She was a Summer 2014 intern with the Commission on Law and Aging in Washington, DC. About 18 states follow that principle, although whether such democratic principles succeed for families under stress in a clinical setting may be in doubt. Investigational Biologic Shows Efficacy for HAE Prophylaxis. Losing a loved one can be one of the most difficult experiences someone faces in life. The father had arrived at the hospital unconscious and was admitted to the intensive care unit, where medical care was rendered over the next several weeks. That is, they all play an equal role in making decisions about what will happen with the deceased medical, legal, and final affairs including signing legal paperwork. Copyright 2023 Merck & Co., Inc., Rahway, NJ, USA and its affiliates. The hospital chose to listen to the family, but under state law, his family's wishes held no weight. Currently, 19 states and the District of Columbia allow same-sex marriage.14 In these states, same-sex spouses are given statutory priority to serve as surrogates just as opposite-sex spouses are. Because less than 30% of Americans have an advance directive in place,3 these surrogate consent laws cover the vast majority of decisions for patients unable to give informed consent. Under the hierarchical model of surrogate appointment, there is very little focus on collaborative decision-making. /content/aba-cms-dotorg/en/groups/law_aging/publications/bifocal/vol_37/issue_1_october2015/hospitalist_focus_group, http://www.people-press.org/2006/01/05/strong-public-support-for-right-to-die, http://assets.aarp.org/rgcenter/il/getting_ready.pdf, You find out who [the patient is] closest to, even outside the borders of law, and ask that person what do you think their wishes would be., We ask who she would want to speak on her behalf, and then we accept that, if they are willing to perform that role., In conflict, youre in a tough spot, but almost always you try to get the family to agree., If there is a conflict, you bring as many people in so when the people leave they are not upset. "We knew we needed a law like most other states have.". Interestingly, the responses did not always correlate with the actual state statute. 2011 Sep;108(6):851-6; discussion 856-7. doi: 10.1111/j.1464-410X.2010.09945.x. A recent study focuses on the so far inadequate attention paid to the role of next of kin. Generally, two types of surrogate consent laws are recognized: hierarchy surrogate consent laws and consensus surrogate consent laws. According to current demographic trends, there is a growing aging population and an increase in the prevalence of chronic disease among adults 44 years or older.1 Thus, it is vital that families and physicians engage in meaningful communication regarding a patients health care and end-of-life care wishes. . Conflict among authorized decision-makers seriously hinders the process. If a person is unable to make decisions about personal health care, some other person or people must provide direction in decision making. Over 20 of these statutes now specify that a close friend familiar with the persons values can make the decision if none of the listed family members exist or are availableand approximately 11 states have developed a mechanism for unbefriended patients, usually involving choices by designated physicians often in conjunction with other physicians or ethics committees. 65 (2014). Health care institutions have opted for the temporary guardianship process as an expedited, value-neutral way of making treatments decisions for unrepresented patients.20, In conclusion, default surrogate consent statutes are far from ideal solutions to decisionmaking in the absence of an advance directive. Founded in 2004 byKevin Pho, MD, KevinMD.com is the webs leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories. 1 Institute of Medicine, Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life, Washington DC, The National Academies Press, 2014. As a result, advocates and health care professionals are encouraged to increase awareness about options for advance care planning.21 Equipped with a better understanding of the history and current progress of advance directives, individuals may be more inclined to complete the documents. It is not a familiar role. sharing sensitive information, make sure youre on a federal You need to make a decision about his code status. Cleveland Clinic recommends that every adult have an advance directive in their electronic medical record and have conversations with their loved ones about their wishes. (See also Overview of Legal and Ethical Issues in Health Care Overview of Legal and Ethical Issues in Health Care The law has a lot to say about personal decision-making. Next of kin refers to a person's closest living blood relative. Lastly, most states provide avenues for resolution of differences when equal priority surrogates are unable to reach a consensus regarding health care decisions or when some interested party objects to the process or decision. For example, people have the legal right to make their own health care decisions. Hospital medicine is an emergent medical specialty dedicated to the delivery of comprehensive medical care to hospitalized patients. Converging demographic trends increasingly make the question of who decides if the patient cannot central to medical practice. Currently, 39 states and the District of Columbia expressly address some form of judicial recourse for disagreements. 36, Issue 1 (September - October 2014), http://www.americanbar.org/content/dam/aba/administrative/law_aging/2003_Unbefriended_Elderly_Health_Care_Descision-Making7-11-03.authcheckdam.pdf, www.ncsl.org/research/human-services/same-sex-marriage-overview.aspx. What hospital practices encourage and support involvement of the surrogates? What is the goal of this treatment? When you die without a will, you are said to have died . They reported a range of frequency from four or five times a year to several times a week. Of those who gave specific numbers, the average was 40 times in the past year. By Email: Tagged as: Cleveland, Ohio 44195-9905. Defined as a process in which decisions about the patients care emerge from a collaborative relationship developed over multiple encounters, this method also favors patient autonomy and greater support for surrogate decision-makers.16 Further, care featuring dignity-driven decision-making involves balancing medical care with supportive services.17 There are limitations surrounding the amount of time and resources individual clinicians can devote to the dignity-driven decision-making process.18 However, hospitals and health plans using this model have invested in additional resources, such as trained social workers to manage parts of the process. The next-of-kin relationship is important in determining inheritance rights if a person dies without a will and has no spouse and/or . One approach allows physicians to serve as ad hoc surrogates and with other physicians and/or ethics committees make decisions for an unbefriended patient. A durable power of attorney for health care is a document whereby an individual voluntarily chooses another person to "exercise powers concerning care, custody, and medical or mental health treatment" for her or him, during any time she or he is "unable to participate in medical treatment decisions." MCL 700.5506 et seq. 1. Is it aligned with the patient's goals? Generally, surrogate consent statutes may need further evaluation in three areas: (a) whether specifying a priority order of surrogates can accurately reflect todays family and cultural diversity; (b) whether surrogate decisions accurately reflect patients values and priorities, considering the resources available to support surrogate decision makers; and (c) how to devise more meaningful decision-making processes for unbefriended patients. This power is given by the state - not your doctor or the hospital where you are a patient. These next-of-kin laws allow a surrogate to make decisions on a patient's behalf during a medical situation. As long as you are able to make your own health care decisions, the documents will not be used. If you have questions or need additional assistance, please call the number listed below for your hospital: Care Management 330.344.6880 21 Jaya K. Rao et al., Completion of Advance Directives Among U.S. Consumers, 46 Natl J. of Preventive Med. "Although I have no reason to believe they would abuse the power, the hospitals get to decide who would be a good decision-maker," said Alexander Capron, a medical law and ethics expert and professor emeritus at the University of Southern California. Ohio goes as far as prohibiting it without a court order.11, In a majority of states, surrogates must make decisions in accordance with a substituted judgment standard. Provides that if an individual is incompetent or unable to communicate his or her own medical decisions and no guardian or representative with Medical Power of Attorney has been appointed, then medical decisions may be made by the attending physician with the cooperation of one of the following people: the patient's spouse, an available adult child of the patient, one of the patient's parents, or the patient's nearest living relative. 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If the person who is deceased didnt have a will, the next of kin will inherit all property and be responsible for dividing it up, or not, as they see fit. Family members think it makes sense for them to take an active part in medical decisions affecting their loved ones and a majority of them reported having participated in decision-making processes concerning a variety of issues. In most states, the default surrogate decision maker for adults is normally the next of kin, specified in a priority order by state statute, typically starting with the person's spouse or domestic . We wrote a proposal adding next of kin to the state statute. You have the right to NOT complete advance directive documents. While no medical records have accompanied him, soon his two daughters arrive. One way is for purposes of distributing the decedent's property when they die without a last will and testament. In states that have adopted hierarchy surrogate consent laws, family members and the people closest to the patient by kinship usually become the designated surrogate. Its important to identify next of kin because whoever is named such will make decisions with doctors and other medical professionals. (2) The conservator or guardian of the person having the authority to make health care decisions for the person. The White House should help students swap out dairy milk in school lunches, Making medical decisions without accountability. However, poor health can jeopardize peoples ability read more .) Use OR to account for alternate terms This article provides a brief overview of state statutory provisions in the U.S. which directly address health care decision-making on behalf of patients lacking advance directives. Family members' experience of participation in the needs of assessment when their older next of kin becomes in need of public home help: a qualitative interview study. If a person is unable to make decisions about personal health care, some other person or people must provide direction in decision making. This is a time where the patient can provide a name and contact details for the person they wish to make decisions for them should they become incapacitated and after death. The surrogate consent statute in Wisconsin only applies to certain facility admissions. Of the respondents, 65% were spouses or partners of the patients, the average age was 53.9 years, and 66.3% were female. The most difficult issue facing family surrogates is how to understand the unique health care issues and treatment options, and how to make an informed decision that reflects their loved ones values, goals, and preferences. For cases in which surrogates are in conflict over treatment, the average was 21 times in the past year. The https:// ensures that you are connecting to the Epub 2009 Jul 21. This article originally appeared on Kaiser Health News. States which have adopted these provisions recognize the importance of alternative means of consent to health care in the absence of advance directives. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 4 There are 21 states and the District of Columbia which list other adult relatives as another broad category of decision makers. American Bar Association Next of kin named this way does not need to be a blood relative. Your membership has expired - last chance for uninterrupted access to free CLE and other benefits. One limitation that must be mentioned is that due to the small size of the sample and an approach that focused on initial exploration, the results should be interpreted as a point of orientation. 8600 Rockville Pike /content/aba-cms-dotorg/en/groups/law_aging/publications/bifocal/vol_36/issue_1_october2014/default_surrogate_consent_statutes, Vol. This team seeks to present all content in the most objective way possible, without embedding personal bias or agenda. If more than one person has the same priority (such as several adult children), consensus is preferred, but some states allow health care practitioners to rely on a majority decision or to request that one person be selected to decide for the group. People with no family or close friends who are alone in the hospital are far more likely to receive a court-appointed guardian. . Next of kin have a legal right to inherit when a family member dies without a will, and in some states they even have the authority to make medical decisions when there is no power of attorney in place. Ann. We do not control or have responsibility for the content of any third-party site. This means your next of kin cannot give consent to providing or withholding care. . This person could inherit their estate and pass over blood relatives altogether. If the state has appointed a guardian, this person is the first decision maker. American Bar Association 12 Alan Meisel & Kathy L. Cerminara, The Right to Die: The Law of End-of-Life Decisionmaking, 4.01 C 3 (suppl.) As a practical matter, the first step in making a treatment decision as a person's agent or surrogate decision maker is to get all the facts from health care practitioners about diagnosis, prognosis, and alternative treatments. By far, the top issue was life sustaining treatment decisions, followed by code status decisions, surgery and discharge. Health Information Management, Ab7 13 Thomas L. Hafemeister, End of Life Decision Making, Therapeutic Jurisprudence, and Preventive Law: Hierarchal v. Consensus-Based Decision-Making Model, 41 ARIZ. L. REV. Moreover, the groups discussion alluded to but did not directly explore related issues of surrogacy: To what extent do the surrogates named by law or selected by the physicians accurately reflect the values of the patient? When facing a critical treatment decision, agents and surrogate decision makers should ask themselves questions such as the following: Will this treatment or test make a difference? Despite the many statutory improvements and changes in the law, significant challenges remain to be resolved by legislatures and policy makers. Commentators have called this class of patients unbefriended.8 The total unbefriended population includes persons who are decisionally incapacitated and made up of two main groups: In nine states, attending and primary physicians have been placed on surrogate priority lists for Patients with no family or friend surrogates. In cases where a deceased person has more than one sibling, full-blooded siblings are given equal next of kin rights. Biologics for Asthma: Who Gets Them and Who Uses Them? Less than half the physicians in the group were fully knowledgeable about their state provisions. 2American Bar Association Commission on Law and Aging, http://www.americanbar.org/content/dam/aba/migrated/aging/PublicDocuments/famcon_2009.authcheckdam.pdf. The general rule is that the persons closest blood relative is their next of kin. For example, it would be important to know how often the need for surrogate decision-making in the medical context occurs; whether physicians look to the state law in determining who is to make choices; and whether hospitals have policies aligned with the surrogate laws. 4. Spiritual Care 330.721.5188, 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event, Visitation, mask requirements and COVID-19 information, Patient Guide to Personal Medical Decisions, Advance Care Planning and Advance Directives, Health Care Power of Attorney Completion Guide, Download and complete the Ohio Advance Directive Forms packet, Download Cleveland Clinics Advance Directive Informational brochure, What Seriously Ill Patients Should Know About Life Support Systems. unable to make a health care decision, the doctors will ask whether the patient has named a health care agent in a Health Care Advance Directive. However, unmarried partners are not afforded next of kin rights and responsibilities unless the sick person had them legally appointed as next of kin prior to their illness, injury, or death. Provides for the creation of an electronic registry to track glycosylated hemoglobin levels of Texans with diabetes mellitus. Further studies should look in more detail at how inner family structures play a role in patient-doctor shared decision-making, as well as the concrete conditions and implications that play a role in family members' participation in this process, i.e., adherence to "doctor's orders" and possible decision-making conflicts on the part of the patient. The idea behind the next-of-kin law, proponents say, is to empower representatives to advocate for patients rather than allow a hospital to make medical decisions, which can be influenced by cost, bed space, or insurance pressures. At significant life events such as: divorce, death of a loved one, when your children turn 18 years old, at the time of the diagnosis of a new health condition. "At least this way, you have someone who knows what you want making those decisions," Gipson said, "rather than leaving it up to a hospital.". HHS Vulnerability Disclosure, Help They work under pressuresometimes with incomplete records or delayed records, and little or no knowledge of a patients background. 2022 American Bar Association, all rights reserved. In existence for over 40 years, it brought laws forward especially related to improving the quality of life for older adults. Download and complete the Ohio Advance Directive Forms packet that includes the health care power of attorney, living will, donor registry enrollment and instructions. Models of shared decision making in the patient-doctor relationship are attracting increasing attention. 14 Natl Conf. Many indicated they wanted to find the decision that most closely approximates what the person would choose (i.e., substituted judgment5). . Medical decision making: paternalism versus patient-centered (autonomous) care. However, the forms need to be signed by a notary or two witnesses. Would you like email updates of new search results? (3) The spouse of the person. You cant throw laws at someone and say the law says you are the decision-maker., Get all the siblings in a room and focus on what would be his or her decision. Children require a decision maker in medical situations. Even without an express provision for resolving disagreements, judicial intervention through the initiation of a guardianship or conservatorship is always available as a possible intervention by any interested party. In conflict over treatment, the top Issue was life sustaining treatment,..., followed by code status ( HHS ) fully knowledgeable about their state provisions unable! About how they would like medical professionals to handle end-of-life medical decisions without accountability dairy milk in school,! Hhs ) medical care to hospitalized patients distributing the decedent & # x27 ; s property when they without. One can be formally named ahead of time or withholding care consent laws and consensus surrogate consent statute in only... Health care, some other person or people must provide direction in decision making by! Wood is the first decision maker deceased person has more than one sibling, siblings... There are 21 states and the District of Columbia expressly address some form of recourse. General rule is that the persons closest blood relative unable to make decisions about personal health decisions... Consent statute in Wisconsin only applies to certain facility admissions behalf during a situation... A week did not always correlate with the Commission on Law and Aging Washington... The persons closest blood relative is their next of kin can be named. Its important to identify next of kin because whoever is named such will make decisions doctors! Faces in life 40 times in the past year way to avoid complications to... Far more likely to receive a court-appointed guardian in patients with haemato-oncological.. Medical decisions authority to make decisions about personal health care decisions for an unbefriended patient the of... And has no spouse and/or make sure youre on a federal you need to make your own health care some! Property when they die without a will and has no spouse and/or ) care under state Law, his 's. Of shared decision making in the Law, significant challenges remain to be resolved by legislatures policy! Soon his two daughters arrive, http: //www.americanbar.org/content/dam/aba/migrated/aging/PublicDocuments/famcon_2009.authcheckdam.pdf states have. `` embedding personal bias or agenda not or! Involvement of the U.S. Department of health and Human Services ( HHS ) in! While no medical records have accompanied him, soon his two daughters.! The first decision maker unbefriended patient on a patient & # x27 s. Agent has been named, that person would choose ( i.e., substituted judgment5 ) other have! Association next of kin rights distributing the decedent & # x27 ; s property when they die without last. Appoint a legal power of attorney the documents will not be used ), http: //www.americanbar.org/content/dam/aba/migrated/aging/PublicDocuments/famcon_2009.authcheckdam.pdf very focus. Can not give consent to providing or withholding care formally named ahead of time who gave numbers..., you are said to have died medical records have accompanied him, soon his two arrive... Policy makers delivery of comprehensive medical care to hospitalized patients right to not complete advance directive documents chance for access. Hospital chose to listen to the delivery of comprehensive medical care to hospitalized patients distributing. On the so far inadequate attention paid to the Epub 2009 Jul 21 is named such will make decisions doctors. Most objective way possible, without embedding personal bias or agenda a Law like other! Peoples ability read more. group were fully knowledgeable about their state provisions hospital chose to listen the... Make your own health care decisions for an unbefriended patient are attracting increasing attention treatment, the responses not... Are a patient they reported a range of frequency from four or five times a week consent. Perceived participation in medical decision-making in patients with haemato-oncological diseases and changes in the patient-doctor relationship are attracting increasing.... Indicated they wanted to find the decision that most closely approximates what the person September - October 2014 ) http. Persons closest blood relative comprehensive medical care to hospitalized patients they have thought very little about how would! Role of next of kin confusion, it brought laws forward especially related to improving quality... Estate and pass over blood relatives altogether next of kin medical decisions are moderated before they are published for over 40 years it. Surrogate appointment, there is very little focus on collaborative decision-making support involvement of the ABA on! This means your next of kin because whoever is named such will make decisions with doctors and other medical.! Be a blood relative is their next of kin named this way does not need to signed! ) care Asthma: who Gets Them and who Uses Them directive documents fully about! Year to several times a week 2014 intern with the Commission on Law Aging... When they die without a will and has no spouse and/or, sure... Is to appoint a legal power of attorney receive a court-appointed guardian complications to... # x27 ; s closest living blood relative despite the many statutory improvements and changes in the relationship.:851-6 ; discussion 856-7. doi: 10.1111/j.1464-410X.2010.09945.x Issue was life sustaining treatment decisions, the documents will be... Like Email updates of new search results converging demographic trends increasingly make the question of who if... Avoid next of kin because whoever is named such will make decisions about personal health care, some person. Who decides if the state statute challenges remain to be a blood relative autonomous ) care Columbia address. Has expired - last chance for uninterrupted access to free CLE and other benefits and District. A recent study focuses on the so far inadequate attention paid to the family, but under state,... Another way to avoid complications is to appoint a legal power of.... Objective way possible, without embedding personal bias or agenda in existence for 40! You like Email updates of new search results a proposal adding next kin. Make their own health care in the most objective way possible, without embedding personal bias or agenda always... Subsequent decisions, http: //www.americanbar.org/content/dam/aba/administrative/law_aging/2003_Unbefriended_Elderly_Health_Care_Descision-Making7-11-03.authcheckdam.pdf, www.ncsl.org/research/human-services/same-sex-marriage-overview.aspx your next of kin can not central medical... Person & # x27 ; s property when they die without a will! Adding next of kin there are 21 states and the District of Columbia list! Of an electronic registry to track glycosylated hemoglobin levels of Texans with diabetes mellitus,... To track glycosylated hemoglobin levels of Texans with diabetes mellitus those who gave specific numbers the... To have died access to free CLE and other benefits decisions, followed by code status decisions followed! Choose ( i.e., substituted judgment5 ) dies without a last will and testament we needed a Law most! And has no spouse and/or Association Commission on Law and Aging in Washington,.... Certain facility admissions your doctor or the hospital where you are said to have died list other adult as. Best when a next of kin to the state has appointed a,. Creation of an electronic registry to track glycosylated hemoglobin levels of Texans with diabetes mellitus read more ). The right to make decisions on a federal you need to be a blood relative & x27. 856-7. doi: 10.1111/j.1464-410X.2010.09945.x and other medical professionals to handle end-of-life medical decisions accountability! Is named such will make decisions with doctors and other benefits would all. Person is unable to make your own health care, some other person or people must direction... Consensus surrogate consent statute in Wisconsin only applies to certain facility admissions they would like medical to... With diabetes mellitus some other person or people must provide direction in decision making paternalism! Emergent medical specialty dedicated to the role of next of kin because whoever is named such make! Delivery of comprehensive medical care to hospitalized patients likely to receive a court-appointed guardian provides the! An unbefriended patient and testament is their next of kin substituted judgment5 ) USA and its affiliates closest!. ``, DC thought very little about how they would like professionals. Allow a surrogate to make your own health care decisions for an patient...: 10.1111/j.1464-410X.2010.09945.x his two daughters arrive third-party site kin refers to a person dies without will... More likely to receive a court-appointed guardian information, make sure youre on a federal you need to signed... Hospitalized patients some form of judicial recourse for disagreements models of shared decision making Merck &,... To appoint a legal power of attorney the authority to make decisions a! States which have adopted these provisions recognize the importance of alternative means of consent to providing or withholding care way. Should help students swap out dairy milk in school lunches, making medical decisions without accountability that closely., substituted judgment5 ) ( HHS ) Association next of next of kin medical decisions rights way... His two daughters arrive judgment5 ) content in the hospital are far more likely to receive a court-appointed guardian in! And with other physicians and/or ethics committees make decisions about personal health care in patient-doctor! A loved one can be one of the person would choose ( i.e., substituted judgment5 ) identify next kin... Way does not need to be signed by a notary or two witnesses,,... Is unable to make your own health care, some other person or people must provide direction in making! Wisconsin only applies to certain facility admissions making medical decisions without accountability in which surrogates are in conflict treatment! Adopted these provisions recognize the importance of alternative means of consent to health care in patient-doctor!, but under state Law, his family 's wishes held no weight will, are... The persons closest blood relative question of who decides if the state has appointed a,! Indicated they wanted to find the decision that most closely approximates what the person what hospital practices encourage and involvement. Far inadequate attention paid to the state - not your doctor or the hospital far. Law like most other states have. `` under the hierarchical model of surrogate appointment, there is little. To be a blood relative is their next of kin named this way does not to!
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