Adults could record care wishes and choose health decision-makers

The proposed substitute sets out how adults may state care wishes and choose someone to make health care decisions for them. These provisions cover adults and emancipated minors making plans for their own health care, including mental health care. An advance mental health directive may prevent revocation during a specified event only if the person follows added signing and witness requirements. The proposal says the rules apply to directives made before, on, or after July 1, 2025.

Health care professionals would assess whether a person can make a health care decision and identify who may decide if the person cannot. These rules address adults who need a health care decision and lack capacity to make it. A person is presumed able to decide unless a court rules otherwise or an authorized professional makes a documented finding under the stated rules. The person may object. In most cases, the finding then needs confirmation by another authorized professional or a court. If there is no available agent or authorized guardian, a default surrogate may decide in the listed priority order, subject to the person's instructions and disqualification rules. A court must hear a request to review a capacity finding within seven days after the petition is filed.

Health care professionals and institutions would follow a person's care instructions and decisions made by an authorized decision-maker, subject to listed exceptions. These provisions apply to health care professionals and institutions providing care to a person with an advance directive or surrogate decision-maker. An agent or default surrogate must follow the person's known wishes and preferences, or decide in the person's best interest if those wishes are not known. Providers may refuse in listed cases, including when care is unavailable or conflicts with certain conscience, medical, or legal limits. They must try to arrange a transfer and provide specified care while one is arranged. Certain intentional violations could lead to lawsuits and damages. A limited exception applies to some claims against emergency medical services providers.