As advancements in medical therapy improve survival, we are confronted with more patients who either cannot communicate or lack decisional capacity, leaving a more common dependency on collaborations with surrogate decision makers. Accompanying these advancements also come radically more complex scenarios to consider that require us to occasionally compromise between quality of life and longevity of life. For instance, modalities such as continuous renal replacement therapy, extracorporeal membrane oxygenation, left ventricular assist devices, and organ transplantation can certainly extend the lives of their recipients, but at a cost of potential complications, time in the hospital, and variable success. Further, the scale between physician-directed decision-making and medical consumerism is weighing heavier toward giving patients a wider breadth of decisional authority in their health care, and the intensive care unit (ICU) is no exception. The recognition of the importance of autonomous decision-making in the latter half of the twentieth century created a need to establish the shared medical decision-making model that incorporates the values and choices of patients with the medical expertise of the physician, as discussed elsewhere in this text (see Chapter 1, When Does Shared Decision-Making Apply in Adult Critical Care?). A natural extension to the increasingly used shared decision-making model requires that we make reasonable efforts to seek the collaboration with surrogate decision-makers when the patient is unable to represent themselves.1