Who's at the table? Moral obligations to equal-priority surrogates in clinical ethics consultations

Existing state surrogate decision-maker laws are fragmented and inconsistent and fail to ensure that all eligible decision makers of the same surrogate priority class are included in the healthcare decisions made for an incapacitated loved one. In this article, we explore three categories of harm that result from failing to include all surrogates of equal priority in a patient's healthcare decision, namely harms to the patient, harms to the excluded surrogate, and harms to the family. Given these harms, we argue that clinical ethicists have a moral obligation to take reasonable steps to include all surrogate decision makers of equal priority in the healthcare decision-making process for patients without a designated healthcare proxy.