Unbefriended and Unrepresented

Medical decision making for the incapacitated and alone

Patients who have lost capacity to make medical decisions and who have no readily identifiable surrogate decision maker are known as "unrepresented" (sometimes referred to as "unbefriended") patients. Estimates range from 5% of ICU deaths and 3-4% of long-term care residents are unrepresented.

These cases raise clinical, ethical and legal questions about who should make decisions for these patients. The unrepresented may eventually fall into the purview of a public guardian or conservator. However, in mmost jurisdictions, this is a time consuming, expensive and resource limited option that is ill suited for complex and often urgent treatment decisions.

This webinar offers clinicians an approach to managing the growing epidemic of unrepresented older adults with a goal of ensuring that treatments are concordant with their preferences, values and best interests.


Eric Widera, Timothy Farrell, Anna Chodos
Eric Widera, Timothy Farrell, Anna Chodos

Eric Widera, MD
Professor of Clinical Medicine, Division of Geriatrics, UCSF

Eric Widera is a clinician-educator in the Division of Geriatrics at the University of California San Francisco. His main goal is to improve the care provided to elderly patients with severe chronic and/or terminal conditions through program development and educational innovations. Dr. Widera accomplishes this through various leadership roles, including Director of the Hospice & Palliative Care Service at the San Francisco VA Medical Center and Program Director for the Geriatrics Fellowship at UCSF. He is also on the Board of Directors for the American Academy of Hospice and Palliative Medicine (AAHPM). Dr. Widera received his medical school training at UCSF and his internal medicine training at Mount Sinai Hospital. He returned to UCSF to complete a fellowship in Geriatric Medicine and joined the faculty at UCSF in August of 2006. Since then, Dr. Widera has been the recipient of numerous grants and awards including a Geriatric Academic Career Award (GACA), the Hastings Center Cunniff-Dixon Physician Award, AAHPM Hospice and Palliative Medicine Leaders Under 40 award, and the AAHPM PDIA Palliative Medicine National Leadership Award. He is also a co-founder of GeriPal, a Geriatrics and Palliative Care blog and podcast, as well as ePrognosis, an online set of prognostic calculators for the elderly.

Timothy Farrell, MD, AGSF
Associate Professor of Medicine, University of Utah School of Medicine

Dr. Timothy Farrell is Associate Professor of Medicine and Adjunct Associate Professor of Family Medicine at the University of Utah School of Medicine, and is a Physician Investigator at the VA Salt Lake City Geriatric Research, Education, and Clinical Center. He also serves as Director of the University of Utah Health Interprofessional Education Program and in this role collaborates with the National Center for Complex Health and Social Needs to lead one of four US Hotspotting Hubs. Dr. Farrell received his A.B. from Dartmouth College and his M.D. from the University of Massachusetts, followed by family medicine residency and geriatric medicine fellowship training at Brown University. Dr. Farrell’s research interests include transitions of care, interprofessional education and practice, and medical ethics. He is a prior recipient of a HRSA Geriatric Academic Career Award (GACA) and was also a Leadership Scholar in the Tideswell/AGS/ADGAP Emerging Leaders in Aging Program. He serves on the Journal for Healthcare Quality, Gerontology, and AGS Geriatrics Review Syllabus (GRS) editorial boards. He also serves as co-chair of the AGS Care Transitions and Tideswell Leaders in Aging Special Interest Groups as well as Vice Chair of the AGS Ethics Committee. Dr. Farrell’s service on the AGS Ethics Committee included leading the 2016 AGS position statement entitled “Making Medical Treatment Decisions for Unbefriended Older Adults.”

Anna Chodos, MD, MPH
Assistant Professor of Medicine, Division of General Internal Medicine
Zuckerberg San Francisco General Hospital

Dr. Anna Chodos is an Assistant Professor of Medicine in the Division of General Internal Medicine at Zuckerberg San Francisco General Hospital (ZSFG) and the Division of Geriatrics, both within the Department of Medicine at UCSF. Her clinical work is in both general primary care and in outpatient specialty care in geriatrics. Her academic work is focused on understanding the unmet needs of older adults who are seen in primary care in the safety net and improving clinical programs. Dr. Chodos is a member of the ZSFG Ethics Committee and a quality improvement leader on ZSFG's work to improve the detection and response to unrepresented status in the outpatient and inpatient settings. She is board certified in Geriatrics and Internal Medicine.

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Frequently Asked Questions

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