Default Health-Care Surrogate Priority in Louisiana

At a glance

Requirements one by one

The consent order

Under § 40:1159.4(A), the adult's own consent comes first. If the adult cannot give it, the order starts with a judicially appointed tutor or curator and an agent under a valid mandate that specifically authorizes health-care decisions. It then lists a spouse who is not judicially separated, an adult child, a parent, a sibling, and other ascendants or descendants. A person in the next class may consent only if no one in a prior class is reasonably available, willing, and competent. The consent covers physician-directed surgical or medical treatment and procedures, including an autopsy, if not prohibited by law.

An adult friend follows those relatives under § 40:1159.4(A)(9). The friend must have shown special care and concern, generally know the patient's health-care views, and be willing and able to act in the patient's best interest. The friend signs and dates a hospital or facility acknowledgment for the medical record. The later paragraphs (A)(11)–(12) provide separate team-selected decision makers for an individual with a developmental disability, with their own selection procedures.

People of equal rank

Section 40:1159.4(B) says a majority of class members available for consultation gives consent when more than one person falls within a class in (A)(1) through (9). Thus, finding one adult child does not by itself settle a decision if other adult children are available for consultation.

Clinician fallback and emergency

Under § 40:1159.4(C), if no person in (A)(1) through (10) is reasonably available, the attending physician may provide treatment or decide on continued services, including placement or transfer. The physician records the needed decision, why delay is inappropriate, and attempts to obtain authorized consent, then obtains a second physician's examination and confirmation. Section 40:1159.4(D) adds search documentation when no contact is listed and records attempted contacts when names are known. This nonemergency process does not apply to an emergency governed by § 40:1159.5(A)–(B), which allows implied consent under its medical-necessity and delay conditions.

What trips people up

The adult friend is a statutory class, but § 40:1159.4(A)(9) requires the facility acknowledgment and familiarity with the patient's wishes. Merely knowing the patient is not enough.

The physician fallback is tied to unavailability, not a general choice between relatives and clinicians. Section 40:1159.4(C) requires the documented steps and a second physician's personal examination before the proposed nonemergency procedure.

Common questions

Can one adult child consent when siblings disagree? Under § 40:1159.4(B), a majority of available adult children in that class must give consent.

Does a mandate need to mention health care? Yes. Section 40:1159.4(A)(3) places an agent in the order only when a valid mandate specifically authorizes health-care decisions.

What if the patient needs care immediately? Section 40:1159.5(A) implies consent when treatment is reasonably necessary, no authorized person is readily available, and delay could jeopardize life or health, disfigure the patient, or impair faculties. Paragraph (B) separately addresses transfer from a licensed facility to a hospital.

Statutes and sources

Verbatim official excerpts, section URLs, and access dates are in the source fields above.