Health: patient directives; Michigan medical treatment decisions act; enact. Creates new act.
SB 482 would create the “Michigan medical treatment decisions act,” establishing a statutory process for certain adults to make medical treatment decisions for an incapacitated patient when the patient cannot participate in decisions and does not have an available patient advocate or guardian. The bill sets a priority list of who may act, beginning with a spouse, then adult child, parent, adult sibling, grandparent, a qualified friend-or-relative surrogate, and finally the attending physician with one other physician if no one else is available. If multiple people are in the same priority class, a majority may decide; if they are evenly split, the attending physician and another physician may help reach a majority.
The bill requires the patient’s inability to participate to be determined in writing by the attending physician and another physician or psychologist, and it requires health care providers to try to notify the patient of who will be making decisions and what decision is being made. The decision-maker must follow the patient’s known wishes and religious beliefs, or if those are unknown, act in the patient’s best interests. The bill also bars these surrogates from authorizing certain major decisions, including withdrawing treatment that would cause death, sterilization, termination of pregnancy, and admission to nursing homes or certain mental health facilities.
In terms of legal impact, the bill would add a new layer of default surrogate decision-making to Michigan law while preserving existing advance directives and patient advocate designations. It expressly does not override POLST forms, do-not-resuscitate orders, nonopioid directives, or a valid patient advocate designation. It also provides liability protection for health care providers who rely in good faith on a person reasonably believed to be acting under the act’s authority, treating the provider as if the patient had made the decision personally.
The overall sentiment reflected by the bill text is practical and protective rather than ideological: it is designed to fill gaps when an adult patient lacks capacity and has no available legal decision-maker. Because there are no committee transcripts or recorded votes provided, there is no documented public debate in the materials about support or opposition. The main policy tensions apparent from the bill itself are between expanding surrogate authority to avoid treatment delays and limiting that authority in sensitive areas such as end-of-life decisions, pregnancy termination, sterilization, and institutional placement.
Notable points of contention likely center on who qualifies as a surrogate, how much discretion physicians have in determining availability and patient incapacity, and whether the prohibitions on certain decisions are too broad or too restrictive. The bill also raises questions about how to handle disagreements among family members of equal priority and how to balance surrogate decision-making with a patient’s expressed objections or previously stated wishes.
The bill would create a new Michigan statutory framework for default medical decision-making for incapacitated adults, affecting health care providers, family members, friends, guardians, and patient advocates. It would interact with and preserve existing laws on advance directives, patient advocate designations, DNR orders, POLST forms, and related public health and estates code provisions, while limiting surrogate authority over specified high-stakes decisions and providing liability protection for providers who rely on authorized decision-makers.
Based on the bill text and the absence of committee testimony or votes, the measure appears to be framed as a consensus-oriented patient-care bill intended to reduce uncertainty when a patient cannot decide for themselves. The structure suggests support for orderly surrogate decision-making, but also caution through strict eligibility rules, physician verification requirements, and categorical limits on certain decisions. No recorded opposition or support is available in the provided materials.
The most likely areas of contention are the scope of surrogate authority, the order of priority among potential decision-makers, and the bill’s categorical prohibitions on withholding life-sustaining treatment, sterilization, pregnancy termination, and certain facility admissions. Family members, guardians, patient advocates, and providers could disagree over who is “reasonably available,” whether the patient is truly unable to participate, and whether a decision reflects the patient’s known wishes. The physician’s role in resolving deadlock and determining objections may also be controversial.