Forrest Lang, MD, Professor in the Department of Family Medicine at East Tennessee State University and Timothy Quill, MD, Professor of Medicine, Psychiatry, and Medical Humanities at the University of Rochester, wrote in their Aug. 15, 2004 article "Making Decisions with Families at the End of Life":

“If there is no advance directive, the physician’s first challenge is to determine whom to approach about critical care decisions. While families frequently choose to involve a large number of connected relatives in these discussions, it is useful to define who has ‘final say.’ Some states have enacted legislation that clearly defines the hierarchy of decision makers, and state law should direct these decisions when applicable. Without legal guidance, the most frequent hierarchy is the spouse, then the adult children, and then the parents.”

Aug. 15, 2004