If a terminally ill or severely injured patient can't voice her preferences about resuscitation, has provided no written instructions, has no next of kin, and hasn't named a health care power of attorney, must the care facility make every attempt to keep her alive, even if it means taking extreme measures?-A.C., PA.

If a patient hasn't made her wishes known and doesn't have a surrogate decision maker to speak on her behalf, the hospital must do everything possible to keep her alive until a court can appoint a guardian to act on her behalf.

When an unresponsive patient is admitted to the hospital and the family hasn't been identified-after a car crash, for example-the hospital has the authority to carry out procedures needed to save her life without getting consent. If she's incompetent or doesn't regain consciousness and has no family or surrogates, the court will appoint a guardian who can make treatment decisions for her.