Oklahoma sets health care decision rules starting July 2027

People can state future care wishes and appoint someone to make health care decisions for them. Adults and minors legally treated as adults can give care instructions, appoint a decision-maker, or do both. Appointing someone requires a signed paper or electronic record and an eligible adult witness. Live video witnessing is allowed; audio-only witnessing requires the witness to know or confirm the person's identity. Earlier care plans remain valid if they meet this law or met the rules where they were made, with this law's limits on stopping life-sustaining treatment. The law takes effect July 1, 2027, and applies to care plans made before, on, or after that date.

An eligible person can make care decisions when a patient cannot and no appointed decision-maker or authorized guardian is available. Unless the patient's plan says otherwise, priority starts with an adult the patient identified, then an eligible spouse, then an adult child or parent. Other eligible relatives or close contacts follow. Decision-makers must follow the patient's known wishes. Otherwise, they must consider the patient's current expressions, values, and treatment risks and benefits when deciding what is best. Patients can reject a default decision-maker. Court findings of danger, specified abuse histories, and facility work can disqualify someone. Facility workers have exceptions for family members, live-in partners, and partners' descendants. Voluntary admission for mental health treatment requires the patient's permission in a recorded care plan and cannot exceed the number of days allowed. Nursing home placement over the patient's objection is barred when a reasonable alternative is possible, unless the patient specifically authorized it in a recorded care plan. Short-term rehabilitation after hospitalization is excepted. Authority generally begins with a finding that the patient cannot decide. It stops when the patient regains that ability or objects to the finding, but can resume after court review or a separate confirming finding.

Patients are presumed able to decide and can challenge a professional's finding that they cannot. These rules cover care decisions, future care instructions, and choosing a decision-maker. Separate rules also limit canceling those choices. Patients must understand the relevant choice and be able to communicate it, including with help or technology. Findings require an examination and written reasons; relatives and the patient's decision-maker cannot make them. An objection generally restores the patient's control unless withdrawn, a court rules otherwise, a serious emergency requires prompt action, or a separate qualified professional confirms the finding. The emergency and second-finding exceptions cannot justify stopping life-sustaining treatment when the patient asks for it to be provided or continued. Courts must appoint a lawyer if needed, hear a challenge within seven days of filing, and decide within seven days after the hearing. A finding that the patient cannot decide requires clear and convincing evidence. Professionals must communicate findings as soon as reasonably possible and record patients' objections.

People can plan mental health care and choose to prevent cancellation of all or part of the plan during a specified crisis. A plan can state treatment preferences or appoint someone to make only mental health decisions. A restriction on cancellation requires a separate signed record and at least two eligible adult witnesses physically present. Witnesses must attest that the person understood the restriction's risks and benefits and chose it freely. The law leaves other rules for involuntary mental health treatment in place. The restriction applies while the person experiences the psychiatric or psychological event named in the plan.

Providers must follow patient instructions and authorized care decisions, with listed exceptions, transfer duties, and court enforcement. These rules cover health care professionals and facilities. Good-faith actions have legal protections, and certain emergency responders have a limited exception from damages for failing to follow care instructions. Providers may refuse for specified reasons involving conscience, unavailable care, accepted medical standards, or law. They must give notice, immediately try to arrange a transfer, and provide required life-sustaining and comfort care while awaiting transfer. An Oklahoma care plan must specifically authorize stopping food or fluids provided by medical means, using the person's own words or a separately marked section. Separate Oklahoma food and fluid protections also apply. For a long-term ventilator user who has accepted routine treatment, stopping it requires that it is no longer needed for life or health, express patient permission, or an incurable condition expected to cause death within two weeks despite treatment. The last exception cannot override a contrary direction or desire for ventilation. Falsifying plans, hiding them to defeat patient wishes, coercing choices, or making care depend on creating or canceling a plan can lead to damages of at least $25,000. Intentional violations of provider duties can bring at least $50,000; larger actual losses can be recovered. During a court challenge to a substitute's life-sustaining care decision and any appeal, courts must order care needed to prevent death unless it would deny the same care to someone else.