Pennsylvania Surrogate Decision Maker Lookup

Who can make medical and money decisions for an adult in Pennsylvania who cannot decide: an agent, a guardian, or Pennsylvania's default surrogate order. Runs in your browser; nothing is stored.

Pennsylvania law checked against official sources on October 26, 2026.

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What needs deciding?
Can the person understand this decision and make it, with help if needed?
Which of these exist? (tick all that apply)

Who has authority in Pennsylvania

  1. With no agent and no guardian, this state's default surrogate law lets a family member or other listed person make health-care decisions, in the order below.
  2. If nobody is available or the family disagrees, a court can appoint a guardian. That is slower and costs more than documents signed in advance.

Pennsylvania's default surrogate order

  1. Anyone the patient designated in a signed writing or by telling the attending physician or provider
  2. Spouse, together with the patient's adult children who are not the spouse's children (Spouse excluded if a divorce action is pending)
  3. An adult child
  4. A parent
  5. An adult brother or sister
  6. An adult grandchild
  7. An adult who knows the patient's preferences and values
What it covers
A health care representative may make health care decisions, with the same authority as a health care agent, for an adult whose attending physician has found the person incompetent, when there is no available agent and no guardian of the person for health care.
If more than one person is in the same group
The provider may rely on a majority of the class members who have shared their views. If the class is evenly divided, no one lower on the list may act.
Who decides the person cannot decide
The attending physician must determine the person is incompetent.
Limits
  • The patient may set a different order in a signed writing, and a willing higher-priority person may take over from a lower one.
  • Care needed to preserve life must be provided to a person who is neither end-stage nor permanently unconscious, unless an authorized agent objects; a representative cannot refuse it.
  • Unless related by blood, marriage or adoption, the attending physician, a provider or the provider's owner, operator or employee cannot serve.
  • The patient may at any time cancel a representative's decision to withhold or withdraw life-sustaining treatment by telling the attending physician, whatever the patient's capacity.
  • A representative's decision takes effect without court approval.

Source: 20 Pa.C.S. 5461 · Checked October 26, 2026

Next steps

Who decides in Pennsylvania without a power of attorney?

Pennsylvania's default surrogate law (20 Pa.C.S. 5461) covers health-care decisions generally. Without a health-care agent or guardian, the first person in line under the statute is: Anyone the patient designated in a signed writing or by telling the attending physician or provider; the first relative listed is: Spouse, together with the patient's adult children who are not the spouse's children.

Pennsylvania's default surrogate law in full

Pennsylvania's default surrogate order

  1. Anyone the patient designated in a signed writing or by telling the attending physician or provider
  2. Spouse, together with the patient's adult children who are not the spouse's children (Spouse excluded if a divorce action is pending)
  3. An adult child
  4. A parent
  5. An adult brother or sister
  6. An adult grandchild
  7. An adult who knows the patient's preferences and values
What it covers
A health care representative may make health care decisions, with the same authority as a health care agent, for an adult whose attending physician has found the person incompetent, when there is no available agent and no guardian of the person for health care.
If more than one person is in the same group
The provider may rely on a majority of the class members who have shared their views. If the class is evenly divided, no one lower on the list may act.
Who decides the person cannot decide
The attending physician must determine the person is incompetent.
Limits
  • The patient may set a different order in a signed writing, and a willing higher-priority person may take over from a lower one.
  • Care needed to preserve life must be provided to a person who is neither end-stage nor permanently unconscious, unless an authorized agent objects; a representative cannot refuse it.
  • Unless related by blood, marriage or adoption, the attending physician, a provider or the provider's owner, operator or employee cannot serve.
  • The patient may at any time cancel a representative's decision to withhold or withdraw life-sustaining treatment by telling the attending physician, whatever the patient's capacity.
  • A representative's decision takes effect without court approval.

Source: 20 Pa.C.S. 5461 · Checked October 26, 2026

How authority works when someone cannot decide

An adult who can understand a decision makes it, even when family disagrees. Authority passes to someone else only when the person cannot decide, and the source of that authority matters.

The strongest source is a document the person signed while able: a health-care power of attorney or advance directive naming an agent for medical decisions, and a durable power of attorney for money and property. A court appointment (a guardian, or in some states a conservator for money) comes next, and it is slower and more expensive.

For health-care decisions only, most states also have a default surrogate law, sometimes called a family consent law. It lists who may decide when there is no agent and no guardian, usually starting with a spouse, then adult children, then parents and siblings. Doctors and hospitals apply it at the bedside.

There is no "next of kin" list for money

Default surrogate laws cover health care, not bank accounts, bills or property. Being a spouse, child or next of kin does not by itself let you sign checks or sell a house for another adult. Without a durable power of attorney, managing someone else's money usually needs a court appointment.

Federal benefits follow their own rules. Social Security says a power of attorney, an authorized representative or a joint account is not the same as being a payee; SSA appoints a representative payee. VA appoints a fiduciary for a beneficiary who cannot manage VA benefits.

What this tool does not do

  • It reports what each state's statute says. It does not decide whether a person has capacity; the treating doctor does.
  • It does not decide disputes between family members or replace a court order. A guardianship order or a power of attorney can change who decides.
  • Hospitals, nursing homes and other states' laws can add steps. Ask the facility's patient-relations or legal office which law it applies.
  • It is general legal information, not legal advice for your situation.

Frequently Asked Questions

Who makes medical decisions in Pennsylvania if there is no power of attorney?

Pennsylvania's default surrogate law (20 Pa.C.S. 5461) covers health-care decisions generally. Without a health-care agent or guardian, the first person in line under the statute is: Anyone the patient designated in a signed writing or by telling the attending physician or provider; the first relative listed is: Spouse, together with the patient's adult children who are not the spouse's children. The full order, tie rule and limits are in 20 Pa.C.S. 5461.

Does next of kin in Pennsylvania have authority over money?

No default surrogate law covers money. In Pennsylvania, as everywhere, managing another adult's accounts or property takes a durable power of attorney or a court appointment.

Sources

Pennsylvania law checked against the official text on October 26, 2026.

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