Medizinische Entscheidungsfindung für bewusstlose Patienten: Rechtliche Hierarchie und Vormundschaft

When a patient lacks decision-making capacity (including due to arrest/detention), authority follows a legally defined hierarchy that varies by jurisdiction. General U.S. framework:

1. Advance directive / Healthcare proxy / Durable power of attorney for healthcare – If the patient executed one, the named agent has legal authority.
2. Court-appointed guardian – If no advance directive, a court may appoint a guardian via a guardianship/conservatorship proceeding.
3. Statutory surrogate hierarchy – Most states specify a default order: spouse → adult children → parents → adult siblings → other relatives → close friend.
4. Treating physician / Hospital ethics committee – In emergencies or when no surrogate is available, the physician acts in the patient’s best interest (presumed consent for life-sustaining treatment).

Critical nuance: “Under arrest” does not automatically strip decision-making rights. The patient retains capacity unless clinically determined otherwise. Law enforcement does not gain medical authority by virtue of custody.

Because state laws differ materially (e.g., some require court order for withdrawal of life support even with a surrogate), consult hospital legal counsel or a healthcare attorney for situation-specific guidance.