Default Health-Care Surrogate Priority in Kentucky
At a glance
| When the default route opens | Physician finds adult lacks decisional capacity; no advance directive exists or it does not address the decision (§ 311.631(1)). |
|---|---|
| Care or setting covered | Health-care decisions generally; psychiatric hospitalization at a general hospital is limited to 14 consecutive days absent court order (§ 311.631(1), (4)). |
| Guardian or appointed agent | Court-appointed guardian within medical powers, then durable-power attorney-in-fact expressly authorized for health care (§ 311.631(1)(a)–(b)). |
| Family and partner order | Spouse; adult child or majority of reasonably available adult children; parents; nearest living relative or same-degree majority (§ 311.631(1)(c)–(f)). |
| Friend or other nonfamily person | Last listed class is adult friend with regular contact and knowledge of patient’s activities, health, and religious and moral beliefs (§ 311.631(1)(g)). |
| Decision within one class | Majority of available adult children or nearest relatives of the same relation; statute does not state a parent vote (§ 311.631(1)(d)–(f)). |
| Who is available and eligible | Higher-priority person must be reasonably available, willing, and competent; friend needs regular contact and familiarity (§ 311.631(1)). |
| Decisions limited or excluded | Follow directive and best interests; psychiatric hospitalization in general hospital capped at 14 days without court order; artificial nutrition withdrawal only in § 311.629(3) circumstances (§ 311.631(3)–(5)). |
| No surrogate or disputed authority | Order passes to next eligible class when a prior class cannot act; friend is final listed class; psychiatric stay beyond 14 days needs court order (§ 311.631(1), (4)). |
Requirements one by one
When the order applies
Under § 311.631(1), the patient's physician must determine that the adult lacks decisional capacity. The responsible-party order applies if there is no advance directive or to the extent a directive leaves the decision unanswered. Each next class may act only if no one in a prior class is reasonably available, willing, and competent.
Priority and selection
Section 311.631(1)(a)–(g) ranks a judicially appointed guardian whose authority covers medical decisions, then an attorney-in-fact under a durable power expressly covering health care. It continues with the spouse, adult children, parents, nearest living relatives, and an adult friend. The friend must have kept regular contact and know the patient's activities, health, and religious and moral beliefs.
Under § 311.631(1)(d), a majority of reasonably available adult children acts when more than one exists. Subsection (f) similarly uses a majority of reasonably available nearest living relatives of the same relation. The parents paragraph does not prescribe a separate class vote. Any decision made under the section must be recorded in the medical record (§ 311.631(2)).
Treatment limits
Section 311.631(3) requires good faith, compliance with any advance directive, and action in the patient's best interest. Under § 311.631(4), psychiatric hospitalization at a general hospital may last no more than 14 consecutive days on this authority unless a court order is obtained under the cited mental-health chapters.
For artificially provided nutrition and hydration, § 311.631(5) sends the decision maker to § 311.629(3). That section permits withholding or withdrawal only under its stated imminent-death, permanently-unconscious-with-directive, inability-to-assimilate, or burden-outweighs-benefit conditions, and preserves nutrition and hydration needed for comfort or pain relief under the listed exceptions.
What trips people up
A parent class appears between adult children and nearest relatives, but § 311.631(1)(e) does not set the same majority formula used for children and nearest living relatives. The actual available people and any conflict require attention to the specific class language.
A designated surrogate under a directive is a different route from this default order. Section 311.631(1) applies when no directive exists or the directive does not answer the decision at hand.
Common questions
Can a close friend act? Section 311.631(1)(g) lists an adult friend after the family classes, with regular-contact and familiarity requirements.
Can a responsible party authorize a long psychiatric hospitalization? Section 311.631(4) caps hospitalization at a general hospital at 14 consecutive days without a court order under KRS Chapter 202A or 202B.
Can this person stop tube feeding? Only in the circumstances incorporated by § 311.631(5) from § 311.629(3), including the provision protecting comfort and pain relief.
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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