This qualitative study examines the judgment standard preferences of older adults related to surrogate decision-making for medical treatment. Thirty community dwelling adults over the age of 60 were presented with scenarios that depicted three decision-making standards, two of which are the predominant legal standards (substituted judgment and best interests), and a proposed third standard that allows the surrogate to consider the interests of the family in the decision-making process (best judgment). Half of the sample preferred substituted judgment, five preferred best interests, and ten chose best judgment. Selected cases are presented that demonstrate the themes associated with each judgment standard preference.