With increased prevalence of chronic and long-term diseases that cause cognitive impairment among elderly patients, surrogate decision making for those who once had decisional capacity is rapidly becoming a special concern. This article considers guidelines and standards for assessing decision-making capacity/incapacity and discusses the issues of who should serve as surrogate decision makers. Empirical evidence is presented showing that the elderly prefer family members to act as surrogates, according to the good faith character of trusted interdependencies.