The family meeting is at four. Your patient can no longer make her own decisions, and she never named anyone to make them for her. On their way: a spouse she hasn't lived with in ten years, a son who calls every Sunday, and the friend who drove her to every appointment. Everyone will assume the family decides together. In New York and Texas, the law says otherwise.
The order. When a patient lacks capacity and has no guardian or health care agent, New York's law picks one person, in a fixed order: the spouse, unless legally separated, or the domestic partner; then an adult child; a parent; an adult sibling; and last, a close friend. Texas runs spouse, adult children, parents, nearest living relative. Neither takes a vote. The spouse she left still outranks the son. If the spouse can't or won't serve, the son is next, and in New York the spouse may also designate him. In Texas, only a court can settle a dispute over who is the surrogate.
The standard. Both laws tell that person how to choose: by what the patient would want. New York adds her religious and moral beliefs and turns to her best interests only when her wishes can't be learned with reasonable diligence. So the question for the meeting is not "What do you want us to do?" It is "What would she tell us if she could?" New York also gives that person a right to the medical information the decision needs and requires providers to give it.
Forgoing life support adds rules in both states. In New York, the surrogate's decision also needs a second physician, NP, or PA to independently concur with the attending's findings on her condition. In Texas, if the attending has certified in writing that her condition is terminal or irreversible and she left no advance directive, the attending and that one person decide together. The decision must be documented in her chart and signed by the attending.
Before the meeting, ask whether she has a guardian or named a health care agent; that person outranks the whole list. Learn your state's rules; your hospital's ethics committee can tell you who decides. And when a patient can still decide, help her name a health care agent and record her wishes now. In New York, her own decision to decline or stop life-sustaining treatment needs no surrogate if she puts it in writing or, during the hospital stay, says it in front of two adult witnesses, at least one of them a health or social services practitioner from the hospital.
Everyone gets a chair at the family meeting. Only one of them speaks for her.