Ideally, medical decisions are made collaboratively by the patient and the healthcare provider. [Page 320]However, when patients cannot fully participate in their own decisions, an alternative decision-making model must be implemented. Surrogates may be required for medical decision making regarding issues of morbidity, mortality, hospital discharge, and research participation. Physicians are faced with the challenge of evaluating decisions made by surrogates. Patients who are unable to contribute to their medical decisions include children and adults who lack capacity, because they either lost or never attained capacity. Adults may lose capacity temporarily or permanently. Temporary loss of capacity may be due to a psychiatric or acute illness, while permanent loss may be the result of an acute event such as brain trauma or a degenerative condition ...