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just as a brief overview we use surrogate decision makers when patients lack decision-making capacity or if theyre declared incompetent by courts typically theyll have a legal guardian appointed who makes all of their decisions surrogate decision makers follow a very specific hierarchy and well talk about that as we get into this video the utilization of surrogate decision makers really does vary state by state depending on the applicable laws but generally speaking on USMLE and comlex the surrogate decision-making hierarchy is mostly accepted as universally true so you wont you wont have to worry about the caveat of you know what state is this question being asked and youre just going to understand the hierarchy and pick the answer based on how we use surrogate decision makers so I think that the best way to approach this topic is to talk about what the hierarchy is for allowing patients to make decisions and then what happens if they cant make their own decisions so obviously