Default Health-Care Surrogate Priority in Tennessee
At a glance
| When the default route opens | Designated physician finds lack of capacity; agent or guardian absent or not reasonably available; provider also checks patient-designated surrogate (§ 68-11-1806(a)–(c)). |
|---|---|
| Care or setting covered | Health-care decisions for adult patients; provider records selected surrogate in current clinical record of treating institution (§ 68-11-1806(b)–(c)). |
| Guardian or appointed agent | Patient may designate an eligible surrogate; agent decision precedes guardian absent court order, and either available decision maker precedes provider selection (§§ 68-11-1806(a)–(c), 68-11-1807(b)). |
| Family and partner order | Selection preference: spouse unless separated; adult child; parent; adult sibling; other adult relative; provider also weighs best-qualified criteria (§ 68-11-1806(c)(3)–(4)). |
| Friend or other nonfamily person | Another adult meeting care, values, availability, and willingness tests may be selected after family preference classes (§ 68-11-1806(c)(2)–(4)). |
| Decision within one class | Provider selects the best-qualified person using statutory criteria; § 68-11-1806(c)(3)–(4) states no same-class majority vote. |
| Who is available and eligible | Adult must know values, show care, be available and willing; protective-order subject and most involved providers excluded; provider may require sworn declaration (§ 68-11-1806(c)(2), (g)–(h)). |
| Decisions limited or excluded | Undesignated surrogate needs two physicians' clinical-record certifications before withholding or withdrawing artificial nutrition or hydration (§ 68-11-1806(e)). |
| No surrogate or disputed authority | If no eligible person is available, designated physician uses ethics recommendations or independent second-physician concurrence; selection challenge carries rebuttable validity presumption (§ 68-11-1806(c)(5)–(6)). |
Requirements one by one
When the default route opens
Section 68-11-1806(b), enacted in 2004 as § 68-11-1706, requires the designated physician to find lack of capacity and an appointed agent or guardian to be absent or not reasonably available. Under § 68-11-1806(a), an adult can personally tell the supervising provider who should serve, orally or in writing. The provider-selection route in subsection (c) applies when that designated person also is not available.
Family and partner order
Section 68-11-1806(c)(3) lists spouse, adult child, parent, adult sibling, other adult relative, then another qualified adult as descending preferences. The wording says consideration "may be given" in that order. Subsection (c)(4) requires attention to who can best reflect known wishes or best interests, recent contact, care, and availability; it does not declare the first relative found to be the surrogate automatically.
Friend or other nonfamily person
An adult outside the family may qualify under § 68-11-1806(c)(2)–(3) by special care and concern, familiarity with the patient's values, reasonable availability, and willingness. The supervising provider documents the selection in the clinical record. A person subject to an order to avoid contact with the patient is ineligible; subsection (g) also restricts treating providers and institutional personnel, with a family-member exception for certain employees.
Decision within one class
Section 68-11-1806(c)(4) directs the provider to identify the person best qualified to serve; subsection (c)(3) states preferences among relationships. It provides no adult-child or sibling majority ballot. A dispute over selection is subject to subsection (c)(6)'s rebuttable presumption of validity and burden on the challenger.
Decisions limited or excluded
Section 68-11-1806(d) directs any surrogate to follow individual instructions and known wishes before using best interests. For a surrogate the patient did not personally designate, subsection (e) allows a decision to withhold or withdraw artificial nutrition or hydration only after the designated physician and an independent second physician make the required clinical-record certifications about prolonging dying and the patient's unlikely return to capacity.
No surrogate or disputed authority
If no eligible person is reasonably available, § 68-11-1806(c)(5) allows the designated physician to decide after obtaining an institution's ethics-mechanism recommendations or concurrence from a second physician who meets the independence conditions. Subsection (f) makes an otherwise authorized surrogate decision effective without advance judicial approval.
What trips people up
The listed kin order in § 68-11-1806(c)(3) is a selection preference, paired with the best-qualified factors in subsection (c)(4). A provider may also require a sworn declaration of claimed authority under subsection (h). Neither a family tie nor a sworn statement by itself replaces the provider's statutory selection and documentation. Under § 68-11-1807(b), an agent's decision precedes a guardian's absent a contrary court order.
Common questions
Does a sibling vote decide between two adult children? Section 68-11-1806(c)(3)–(4) supplies preferences and qualifications, not a cross-class vote or an adult-child majority rule.
Must the patient sign a document to name a surrogate? No. Section 68-11-1806(a) permits an oral designation personally communicated to the supervising provider.
Can the physician act if no family member can be found? Yes, after the search and consultation conditions in § 68-11-1806(c)(5) are met.
Statutes and sources
- Tenn. Code Ann. §§ 68-11-1806–1807 (enacted in 2004 Public Chapter 862 as §§ 68-11-1706–1707). Verbatim official enactment text, source link, and access date appear in the source fields above.
Source links
Every statute quoted above, linked, with the date we checked it.
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