Default Health-Care Surrogate Priority in District of Columbia
At a glance
| When the default route opens | No health-care power of attorney; incapacity certified in writing by physician plus qualified psychologist or psychiatrist after timely examination (§§ 21-2204, 21-2210(a)). |
|---|---|
| Care or setting covered | Consent, refusal or withdrawal for any health-care service, treatment or procedure; no single-facility limit in this section (§ 21-2210(a)). |
| Guardian or appointed agent | Court-appointed guardian or conservator within appointment scope; then court-appointed intellectual-disability advocate within scope (§ 21-2210(a)(1)–(1A)). |
| Family and partner order | Spouse or domestic partner; adult child; parent; adult sibling; qualified religious superior; close friend; nearest living relative (§ 21-2210(a)(2)–(6)). |
| Friend or other nonfamily person | Religious superior for member of an order or diocesan priest; close friend with significant care, regular contact and familiarity; treating-provider interests disqualify friend (§§ 21-2202(1A), 21-2210(a)(5A)–(5B), (g)). |
| Decision within one class | Listed classes have priority; § 21-2210 sets no same-class voting formula, but listed persons may challenge a higher-priority decision in Superior Court (§ 21-2210(a), (e)). |
| Who is available and eligible | Next class only when prior class lacks a reasonably available, mentally capable and willing person; one witness for consent by persons in (a)(2)–(6) (§ 21-2210(c)–(d)). |
| Decisions limited or excluded | Follow known wishes or good-faith best interests; court order needed for abortion, sterilization, psychosurgery, convulsive therapy or aversive behavior programs (§§ 21-2210(b), 21-2211). |
| No surrogate or disputed authority | Provider or interested person may petition Superior Court for guardian if nobody can act; priority presumption may be rebutted for better knowledge of wishes or interests (§ 21-2210(e)–(h)). |
Requirements one by one
When the default route opens
The District requires the § 21-2204(a) incapacity certification before the § 21-2210(a) substitute-consent order operates. One certifier must be a physician and the other a qualified psychologist or psychiatrist. At least one must examine the patient within the preceding day; both give written opinions on the cause, nature, extent and likely duration of the incapacity. Section 21-2204(b) requires the written findings in the patient-care record and ties incapacity to the particular decision or communication.
Family and other eligible people
The order in § 21-2210(a) starts with a court-appointed guardian or conservator, and then a court-appointed intellectual-disability advocate, each only within the appointment's consent scope. It then lists spouse or domestic partner, adult child, parent, adult sibling, a religious superior for a member of a religious order or diocesan priest, close friend, and nearest living relative. Section 21-2202(1A) defines a close friend through significant care, regular contact and familiarity with the patient's life, health and beliefs.
Who is available and eligible
Under § 21-2210(d), the next class acts when nobody in the earlier class is reasonably available, mentally capable and willing. For a decision by someone listed in paragraphs (a)(2) through (6), § 21-2210(c) requires at least one witness to be present. The statute's close-friend category excludes a treating provider and the listed people who own, run or work for that provider (§ 21-2210(g)).
Decisions limited or excluded
The decision must follow known patient wishes; if those cannot be found, the decision-maker uses a good-faith belief about the patient's best interests (§ 21-2210(b)). Section 21-2211 requires court authorization before a substitute decision-maker consents to abortion, sterilization, psychosurgery, convulsive therapy or an aversive-stimulus behavior program.
No surrogate or disputed authority
If no listed person is reasonably available, mentally capable and willing, § 21-2210(h) permits the provider, the District in the stated habilitation setting, or an interested person to petition Superior Court for a guardian. A listed person may challenge a higher-priority decision there; subsection (f) lets the priority presumption be rebutted by a lower-priority person with better knowledge of the patient's wishes or interests.
What trips people up
The § 21-2210(c) witness rule applies to a spouse or partner and the other noncourt representatives in paragraphs (a)(2) through (6); it is separate from the two professionals who certify incapacity under § 21-2204. The priority list is presumptive, and the court may hear a challenge under § 21-2210(e)–(f).
Common questions
Can a close friend decide?
Yes, in the listed position after a qualifying religious superior and before the nearest living relative, if earlier classes cannot act. The friend must meet § 21-2202(1A)'s relationship definition and § 21-2210(g)'s provider-conflict rule.
What if no listed person can act?
The provider or an interested person may ask Superior Court to appoint a guardian under § 21-2210(h).
Statutes and sources
- D.C. Code § 21-2202 — official section (accessed 2026-10-08).
- D.C. Code § 21-2204 — official section (accessed 2026-10-08).
- D.C. Code § 21-2210 — official section (accessed 2026-10-08).
- D.C. Code § 21-2211 — official section (accessed 2026-10-08).
Source links
Every statute quoted above, linked, with the date we checked it.
What does District of Columbia law mean for your facts?
You just read the general rule. Ask your own question and see which parts of current District of Columbia law apply to your situation, with citations you can check.
Opens in Ezel Pro.
- Starts from the statutes this survey is built on
- Cites every source it relies on, so you can verify it
- Chat, drafting and research in one workspace