You're really, really wrong. In the absence of legal documents the spouse comes next. While the spouse may then try to figure out what the patient would've wanted, they ultimately have the final say.
According to Dr Steven R. Daugherty (Kaplan Lecture Notes):
If you cannot talk directly with the patient, use one of the three principles
in this order:
1. Subjective standard (advance directive)
2. Substituted judgment
3. Best-interest standard
1.
Subjective Standard (Advance Directive)
What has the patient said in the past?
• Oral or written statements are the same.
• Decision expressed to you or to someone else is the same.
• If multiple statements have been made by the patient, the most recent statement prevails.
2. Substituted judgment
Someone who knows the patient offers a best guess about what the patient would want.
• Consider the people presented and decide who is best to guess patient's wishes.
• Next of kin is not the issue, rather, who can best guess the patient's wishes.
• Next of kin often will be among the best people to guess.
• But knowledge of the patient, not blood relationship, is the determining issue.
• Example: Karen Ann Quinlan case.
• Note that
this is not about what the patient said to someone. If that occurred, it would be back to the subjective standard.
3. Best- Interest Standard
What would most patients in this situation want?
To summarize, children are conveying the Advance Directive while wife is using Substituted judgment.
