Erica F. Wood, JD, Assistant Director of the American Bar Association Commission on Law and Aging, in an Oct. 2015 article "If There Is No Advance Directive or Guardian, Who Makes Medical Treatment Choices?," available at, stated:

“In situations in which the patient is not able to give informed consent for treatment, and there is no guardian and no advance directive, some 44 states have ‘default surrogate consent laws’—formerly commonly known as ‘family consent laws.’ These laws generally provide a hierarchy of authorized family decision-makers who in descending order starting with the spouse can make medical treatment decisions on someone’s behalf. Over 20 of these statutes now specify that a ‘close friend’ familiar with the person’s values can make the decision if none of the listed family members exist or are available—and 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.”

Oct. 2015