DESIGNATED HEALTHCARE DECISION MAKER ACT

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.