Default Health-Care Surrogate Priority in Alabama
At a glance
| When the default route opens | No adequate directive or available appointed proxy; attending physician finds lasting inability to decide, and two physicians certify terminal illness/injury or permanent unconsciousness (§ 22-8A-11(a)). |
|---|---|
| Care or setting covered | Surrogate ladder covers only life-sustaining treatment and artificially provided nutrition or hydration, in consultation with the attending physician (§§ 22-8A-3(10), 22-8A-11(a)). |
| Guardian or appointed agent | Judicial guardian only if specifically authorized for these decisions; otherwise available appointed health-care proxy precedes default surrogate (§ 22-8A-11(a), (d)(1)). |
| Family and partner order | Eligible spouse; one adult child; one parent; one adult sibling; then one surviving adult relative in the next closest kinship degree (§ 22-8A-11(d)(2)–(6)). |
| Friend or other nonfamily person | If no relatives are known or found after reasonable inquiry, a unanimous treating-physician/ethics-committee or specified substitute committee may decide (§ 22-8A-11(d)(7)). |
| Decision within one class | One eligible relative may serve, but surrogate must certify contacted equal- and higher-class people consented or did not object; specified unreachable people are excluded (§ 22-8A-11(d)–(f)). |
| Who is available and eligible | Competent adult; prior classes unavailable or unwilling. Surrogate certification is signed before two witnesses age 19+ (§ 22-8A-11(b), (d), (i)). |
| Decisions limited or excluded | Patient’s known values guide decision; artificial nutrition/hydration withdrawal for permanent unconsciousness needs clear-and-convincing evidence of desires (§ 22-8A-11(c)). |
| No surrogate or disputed authority | A qualified unanimous facility committee may act when relatives cannot be found; circuit court may hear challenges or competing authority claims (§ 22-8A-11(d)(7), (j)). |
Requirements one by one
The narrow decision covered
Under § 22-8A-11(a), the surrogate route opens when no advance directive has been made, no appointed health-care proxy is reasonably available, or a valid directive leaves the circumstance unanswered. The attending physician must determine that the adult can no longer understand, appreciate, and direct treatment and has no hope of regaining that ability. Two examining physicians must record a terminal illness or injury or permanent-unconsciousness diagnosis; the treating physician must also determine that withholding or withdrawing treatment will not cause undue pain or discomfort. The statute covers decisions about life-sustaining treatment and artificially provided nutrition and hydration, as defined in § 22-8A-3(10).
Priority and selection
Section 22-8A-11(d) first permits a judicially appointed guardian whose appointment specifically authorizes these decisions. It then lists a spouse who is neither legally separated nor party to divorce proceedings, one adult child, one parent, one adult sibling, and one surviving adult relative in the next closest degree of kinship. A guardian appointment is not required before every decision under this chapter. An available appointed proxy normally precedes this default route under § 22-8A-11(a).
One listed relative can serve, but § 22-8A-11(e) requires that surrogate to certify contact with one or more people in equal or higher classes and that each class consented or did not object to the surrogate or decision. Subsection (f) preserves a decision when a necessary person cannot be contacted for its stated reasons; the person's class is then excluded from the consent or non-objection count. Under subsection (i), the certification form needs the surrogate's signature and signatures of two witnesses at least 19 years old.
Limits and fallback
Section 22-8A-11(c) directs the surrogate to approximate the patient's own choice using known religious, spiritual, personal, philosophical, and moral beliefs, without deciding for financial advantage. For a permanently unconscious person, withholding or withdrawing artificial nutrition and hydration needs clear-and-convincing evidence of the patient's desires.
If no relatives are known or found after reasonable inquiry, § 22-8A-11(d)(7) allows a unanimous committee involving the primary treating physician and the facility ethics committee, or a specified substitute committee. A provider must notify the Department of Human Resources when that committee route is used. Under § 22-8A-11(j), a directly involved person may ask the circuit court for declaratory and injunctive relief to contest authority or the decision; a provider facing rival surrogate claims may seek declaratory relief.
A court-appointed guardian has a separate route for broader medical consent. Section 26-2A-108(a) gives an adult guardian duties and powers cross-referenced to § 26-2A-78(c)(4), which expressly permits consent to medical or other professional care. Under § 26-2A-105(c), the court may limit those powers. This guardian route does not expand the family surrogate's narrow power under § 22-8A-11.
What trips people up
The adult-child, parent, and sibling entries in § 22-8A-11(d) say one person may serve. That person still must satisfy the separate contact and no-objection certification under subsection (e); one-person eligibility is not unilateral authority over an objecting equal class.
The committee route is not a general close-friend appointment. Section 22-8A-11(d)(7) applies only after reasonable inquiry fails to locate relatives and requires unanimous committee action.
Common questions
Does the surrogate decide ordinary medical care? Section 22-8A-11(a) specifies life-sustaining treatment and artificial nutrition or hydration. A court-appointed guardian's separate medical-consent powers appear in §§ 26-2A-108(a) and 26-2A-78(c)(4).
Can a separated spouse take the spouse rank? No. Section 22-8A-11(d)(2) excludes a legally separated spouse or one who is party to a divorce proceeding.
Where does a challenge go? Section 22-8A-11(j) names the circuit court for a challenge to a surrogate's authority or treatment decision, or for a provider confronted by competing claimants.
Statutes and sources
Verbatim official excerpts, section URLs, and access dates are in the source fields above.
Source links
Every statute quoted above, linked, with the date we checked it.
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