A Legal and Ethical Analysis of the Effects of Triggering Conditions on Surrogate Decision-Making in End-of-Life Care in the US J. Clint Parker 1 • Daniel S. Goldberg 1 Published online: 18 June 2015 Ó Springer Science+Business Media Dordrecht 2015 Abstract The central claim of this paper is that American states’ use of so-called ‘‘triggering conditions’’ to regulate surrogate decision-making authority in end-of- life care leaves unresolved a number of important ethical and legal considerations regarding the scope of that authority. The paper frames the issue with a case set in a jurisdiction in which surrogate authority to withdraw life-sustaining treatment is triggered by two specific clinical conditions. The case presents a quandary insofar as the clinical facts do not satisfy the triggering conditions, and yet both the appro- priate surrogates and the care team agree that withdrawal of life-sustaining treat- ment is in the best interest of the patient. The paper surveys applicable law across the 50 states and weighs the arguments for and against the inclusion of such trig- gering conditions in relevant legal regimes. The paper concludes by assessing the various legal and policy options states have for regulating surrogate decision- making authority in light of the moral considerations (including epistemic diffi- culties), and notes the possibility for conflict within ethics teams arising from the potential tension between prudence, risk-aversion, and moral obligation. Keywords Triggering conditions Á End-of-life care Á Surrogate decision-making Á Obligation Á Safe harbors & Daniel S. Goldberg goldbergd@ecu.edu J. Clint Parker parkerjo@ecu.edu 1 The Brody School of Medicine, East Carolina University, 600 Moye Blvd, MS 641, Greenville, NC 27834, USA 123 HEC Forum (2016) 28:11–33 DOI 10.1007/s10730-015-9279-3