Establishes the "Designated Health Care Decision-Maker Act", which authorizes certain persons to make health care decisions for certain incapacitated persons
HB 1886 creates the “Designated Health Care Decision-Maker Act” and adds eleven new sections to Missouri’s Chapter 404 governing health care decision-making for incapacitated adults. The bill establishes a process for identifying when a patient lacks capacity, requires physicians to make reasonable efforts to locate potential decision-makers, and sets a priority list of people who may make decisions if the patient has no guardian, health care power of attorney, or other legally authorized representative. That priority list begins with a spouse, then adult children, parents, adult siblings, grandparents or adult grandchildren, more distant relatives, certain religious community members, close nonrelatives, and finally another person chosen by unanimous agreement of those listed.
The bill also directs designated decision-makers and courts to act in the patient’s best interests and, when known and consistent with those interests, in accordance with the patient’s religious and moral beliefs and preferences. It limits when artificial nutrition and hydration may be withdrawn, generally allowing it only when two physicians certify that it is not needed for comfort or pain relief and is only prolonging the dying process, or cannot be physiologically tolerated. It also gives designated decision-makers access to medical information under HIPAA and allows probate court petitions for temporary or permanent guardianship when there is disagreement about care.
HB 1886 would affect Missouri law by creating a new statutory framework for surrogate health care consent, adding protections for providers who act in good faith, and requiring continued care pending transfer if a provider objects on religious or moral grounds. It also bars withholding or withdrawing health care from pregnant patients, incorporates existing incapacity standards, and expressly states that the act does not authorize euthanasia or mercy killing. The bill would therefore interact with guardianship law, durable powers of attorney for health care, probate court procedures, and health care facility obligations.
The overall sentiment reflected in the bill text is strongly protective of life, patient welfare, and family or close-person involvement in decision-making. The structure emphasizes access to care, continuity of treatment, and deference to the patient’s known values while also accommodating provider conscience objections through transfer provisions. Because there are no committee transcripts or recorded votes provided, there is no direct evidence of public debate or legislative support/opposition in the available materials.
The main points of potential contention are the limits on withdrawing artificial nutrition and hydration, the role of nontraditional decision-makers such as close nonrelatives or religious community members, and the balance between patient autonomy, family authority, and provider conscience rights. Another likely issue is the bill’s treatment of pregnancy and its restrictions on end-of-life decisions, which may be viewed as protective by supporters but as limiting by critics who favor broader patient-directed care.
HB 1886 would add a new subchapter to Missouri’s health care decision-making laws, creating statutory authority for a designated surrogate decision-maker when an adult patient is incapacitated and lacks a guardian, health care power of attorney, or other legally authorized representative. It would also establish procedures for incapacity determinations, notice to potential decision-makers, priority rules for surrogate selection, probate court involvement in disputes, HIPAA access for the surrogate, and liability protections for providers acting in good faith. The bill would further restrict withdrawal of nutrition and hydration, require continued care during transfers, prohibit withholding care from pregnant patients, and preserve existing guardianship and advance directive law where applicable.
The bill’s tone and structure suggest generally supportive sentiment toward preserving life, protecting incapacitated patients, and clarifying who may speak for a patient when no formal advance directive exists. It also reflects concern for religious liberty and provider conscience by allowing objections and transfer rather than forced participation. No votes or committee testimony were provided, so the available record does not show measured support or opposition from legislators, stakeholders, or the public.
Likely areas of contention include the bill’s strict limits on withdrawing artificial nutrition and hydration, especially the requirement for dual physician certification and the preference for natural feeding. Another point of debate is the broad surrogate hierarchy, which includes close nonrelatives and religious community members, and the bill’s allowance for provider refusal based on religious or moral convictions. The prohibition on withholding care from pregnant patients and the bill’s explicit anti-euthanasia language may also draw disagreement from those concerned about patient autonomy or end-of-life decision-making.