Introduction
A Designated Healthcare Decision Maker is an individual authorized
by law to make healthcare decisions on behalf of an incapacitated patient that
does not have an Attorney-in-Fact for healthcare decisions.
Missouri is 1 of 6 states that does not have a Healthcare
Decision Maker Law.
When a medical situation is urgent, the delay in obtaining a
court-ordered guardianship may jeopardize the patient's health and place large
financial burdens on the family.
There exists proposed legislation to amend chapter 404,
RSMo, by adding thereto 11 new sections relating to Designated Healthcare
Decision-Maker’s authority for medical treatment of an incapacitated patient.
A healthcare provider or healthcare facility may rely in
good faith upon the healthcare decisions made for an incapacitated patient by a
Designated Healthcare Decision Maker, provided two licensed physicians
determine that the patient is incapacitated and does not have:
A guardian with medical decision-making authority appointed
in accordance with section 475.010 et seq.;
An attorney in fact appointed in a durable power of attorney
for healthcare; or
Any other known person with the legal authority to make healthcare
decisions for the incapacitated patient.
If a patient is unable to consent, decisions concerning the
patient's healthcare may be made by the following competent persons in the
following order of priority:
Spouse
Adult child
Parent
Adult sibling
Grandparent or adult grandchild
Niece, nephew, or next nearest blood relative
A nonrelative who is reasonably believed by the physician to
have a personal relationship with the patient and is familiar with the
patient’s personal values; or a person designated unanimously by the persons
listed above who are involved in the patient’s care.
Priority of a Healthcare Decision Maker is not given if:
The healthcare provider or healthcare facility has
reasonable cause to make a report of abuse or neglect against an individual for
treatment of the incapacitated patient, then that individual will not be given
authority or priority to make any healthcare decisions for the patient.
The persons of equal priority as listed above do not
unanimously agree with regard to the healthcare to be provided to the patient,
they may file a petition seeking the appointment of a temporary or permanent
guardian for the incapacitated patient.
The healthcare provider or healthcare facility has made reasonable
attempts to contact the designated healthcare decision-maker using known
telephone numbers and other contact information and receives no response.
The healthcare provider or healthcare facility for the
incapacitated patient has knowledge that before becoming unable to consent, the
patient did not want the authorized person involved in decisions concerning the
patient's care.
The Designated Healthcare Decision Maker cannot override the
best interests of the incapacitated patient.
Any healthcare services that the patient has unambiguously,
without contradiction or change of instruction, expressed to their healthcare
provider when the patient had capacity shall be honored.
No Designated Healthcare Decision Maker may, with the intent
of causing the death of the patient, authorize the withdrawal of nutrition or
hydration which the patient may ingest through natural means.
Artificially supplied nutrition and hydration may be
withheld or withdrawn during the pendency of a guardianship proceeding only if
the patient’s physician and a second licensed physician certify that the
patient cannot tolerate it.
The Designated Healthcare Decision Maker’s authority is not absolute.
Nothing within the proposed legislation permits any
affirmative or deliberate act to end the patient’s life.
The rights of the Designated Healthcare Decision Maker end
upon the physician’s certification that the patient is no longer incapacitated.
No designated healthcare decision-maker may, with the intent
of causing the death of the patient, authorize the withdrawal of nutrition or
hydration which the patient may ingest through natural means.
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