Who decides for you? Default decision-maker laws in all 50 states

Most of us picture a simple scene: we're in the hospital, can't speak for ourselves, and the person who knows us best steps up. Maybe a partner we never married, or a sister across the country. Maybe the friend who has a key to the house and walks the dog.

The law often pictures something different.

When nobody has been named in writing, each state has its own rule for who decides, and the rules vary a great deal. This page is part of our guide to who decides when you can't. It lays out the rule in every state and D.C. as of October 2026. If you'd rather not leave it to the list at all, see your options for naming someone ahead of time.

How the default rule works

If you never signed a medical power of attorney (some states say health care proxy), doctors look to state law. In most states that law is a ranked list.

A court-appointed guardian, if there is one, usually comes first. Then a spouse, then adult children, then parents, then adult brothers and sisters.

After that, states split. Some keep going through grandchildren, nieces, nephews, aunts and uncles. About 30 states and D.C. eventually reach a close friend, almost always at the very end of the line.

Nine states list relatives only. Four states, by the American Bar Association's count, have no general default law at all.

Why this matters more than most people think

Many people assume the person who shows up will be the person who decides. Often that isn't true. An unmarried partner of twenty years may rank below a parent, or may not be on the list at all.

A close friend usually ranks below every relative the hospital can find. That includes a niece you haven't seen in a decade. In some states the friend must also sign a sworn statement before a doctor will listen.

Here is a typical case, a composite: Ruth, 71, has a stroke in Texas. Her closest friend of thirty years sits by her bed every day.

Texas law gives her friend no role in consent. So the hospital calls Ruth's nephew in Ohio, who hasn't seen her since a wedding in 2009.

None of this is anyone's fault. Default laws were written for a typical family that many of us don't have. The good news is that they only apply when you haven't named someone yourself.

Where these numbers come from

We started from the American Bar Association Commission on Law and Aging chart, Default Surrogate Consent Statutes. It is the standard national reference.

The newest version we could find is dated October 2022. A January 2023 ABA article counted 46 states with default surrogate laws. The four without were Massachusetts, Minnesota, Missouri and Rhode Island.

Statutes change, and some have changed since 2022. So in October 2026 we read the current statute text for Washington, California, Florida, Texas, New York, Illinois, Oregon and Arizona. We also read Delaware's and Utah's laws, which were rewritten after the chart came out.

Oklahoma has passed a new law too, but it doesn't take effect until July 1, 2027. We read it and note it in the table.

For the other states, the table repeats the ABA chart's summary and says so in the last column. The ABA itself warns that its chart gives broad descriptions, not the exact words of each law.

How to read the table

• Statute is the section of state law that sets the order. Where a state has more than one, we list the main one.
• Default order is a plain summary of who comes first, second and so on. A guardian, and anyone you named in a medical power of attorney, almost always outranks this list.
• Close friend can decide? uses five answers:
• Yes: a friend is on the list, nearly always last. Most states require a friend who has kept in regular contact and knows your health and values.
• Limited: a friend appears only in a narrow law, such as one covering life support or nursing home admission.
• Unclear: the law's wording or the chart's summary leaves real doubt.
• No: the list covers relatives only.
• No law: the state has no general default list. Without a named decision-maker, families may need a court.
• Verified says whether we read the current statute ourselves in October 2026, or relied on the ABA chart (October 2022).

Default decision-maker laws in all 50 states and D.C.

What the table shows

Here is the tally. A friend can be a default decision-maker in 30 states and D.C., though always behind family. In five more states a friend shows up only in a narrow law.

Nine states list relatives only, two are unclear, and four have no general list.

Three patterns stand out.

• Friends come last. Even in the friendliest states, a close friend steps in only when every listed relative is missing, unwilling or unable.
• Friends often have to prove it. Washington, Florida, Illinois and New York ask the friend for a signed statement about knowing you. In Washington it is sworn under penalty of perjury, and the hospital may still decline to rely on it.
• Ties can stall things. Many states let a majority of your adult children decide. Washington requires everyone in the same group who is available to agree. A disagreement among siblings can stop a decision cold.

Washington, step by step

Washington's rule, in RCW 7.70.065, is a long one. Here is the order, from the current text:

1. A court-appointed guardian.
2. The person named in a health care power of attorney.
3. A spouse or state registered domestic partner.
4. Adult children.
5. Parents.
6. Adult brothers and sisters.
7. Adult grandchildren who are familiar with you.
8. Adult nieces and nephews who are familiar with you.
9. Adult aunts and uncles who are familiar with you.
10. A close friend who meets the law's tests.

The friend must have shown special care and concern for you and know your personal values. They can't be your doctor, a paid caregiver, or staff at the facility where you live.

They must sign a declaration, good for six months. It says they have kept regular contact and know of no willing relative higher on the list.

If anyone higher on the list refuses, a lower person can't consent. And if two people in the same group disagree, neither can consent.

What to do about it

Every rule in this table is a fallback. It applies only if you haven't named someone yourself. The fix is a single document: a medical power of attorney, signed while you can still sign it.

With one in place, your medical power of attorney comes ahead of every spouse, child, parent and sibling on these lists. In every state in this table, it is also the simplest way to make sure a close friend can decide.

A few steps make it work:

1. Choose the person. Our guide to choosing a medical power of attorney walks through what to look for. If the right person is a friend, read about naming a friend as power of attorney.
2. Name a backup. People move, get sick or can't be reached. A second name keeps you from falling back onto the default list.
3. Write down what matters. An advance directive records your wishes, so whoever decides isn't guessing.
4. Tell people and keep copies. The hospital has to know the document exists. Give copies to the people you named and your doctor.

Some people would rather not put a friend or relative in that spot. Others want a professional standing by behind the person they chose.

Our pages on a friend versus a professional and an attorney, trust company or family compare the options. Kinly members can name Trella Trust Company as medical power of attorney, first or as backup to someone they choose. See how Kinly works.

Common questions

Can a close friend make medical decisions if I don't have a power of attorney?

In about 30 states and D.C., yes, but only after the hospital has tried every relative on the state's list. Many states also require the friend to sign a statement about your relationship. In Texas, Kentucky, Ohio and several other states, a friend has no default role at all.

Can an unmarried partner decide for me?

It depends on the state. Some list a domestic partner or a "spouse-like" partner high up, as Maine, New Mexico, Delaware and Utah do. Elsewhere, an unmarried partner may count only as a close friend, at the bottom of the list. Naming your partner as your medical power of attorney removes the doubt.

What happens if my state has no default decision-maker law?

In Massachusetts, Minnesota, Missouri and Rhode Island, there is no general list. Without a named decision-maker, someone may need to ask a court to appoint a guardian. Our page on guardianship versus power of attorney explains how that works.

Who decides if relatives disagree?

Each state handles it differently. Some go with the majority of adult children or siblings, some send disputes to an ethics committee, and some require a court. Washington requires everyone available in the same group to agree; otherwise that group can't consent.

Do these laws cover every medical decision?

Not always. Some apply only to life support, as in Oregon, Ohio and Iowa, or only in certain settings, as in New York and Wisconsin. Our overview of medical decisions without a power of attorney covers what happens when papers are missing or unclear.

Sources

• ABA Commission on Law and Aging, Default Surrogate Consent Statutes (as of October 2022)
• ABA Commission on Law and Aging, Bifocal: Recent Updates to Default Surrogate Statutes (January 2023)
• Washington, RCW 7.70.065
• California Probate Code §4712
• Florida Statutes §765.401
• Florida Statutes §765.101 (definition of close friend)
• Texas Health and Safety Code chapter 313 (§313.004)
• Texas Health and Safety Code chapter 166 (§166.039)
• New York Public Health Law §2994-d
• New York Public Health Law §2994-a (definitions)
• Illinois, 755 ILCS 40/25
• Illinois, 755 ILCS 40/10 (definitions)
• Oregon Revised Statutes chapter 127 (§127.635)
• Arizona Revised Statutes §36-3231
• Delaware Code title 16, chapter 25 (§2512)
• Utah Code §75A-9-111
• Oklahoma HB 1687, enrolled (effective July 1, 2027)