SB 1536 creates the “Designated Health Care Decision-Maker Act” and adds ten new sections to Missouri law governing who may make medical decisions for an incapacitated adult when there is no guardian, health care power of attorney, or other legally authorized decision-maker. The bill establishes a hierarchy of eligible decision-makers, beginning with a spouse, then adult children, parents, siblings, grandparents or adult grandchildren, more remote relatives, certain religious community members, close nonrelatives, and finally another person chosen by unanimous agreement of those involved in the patient’s care. It also requires physicians to make reasonable efforts to identify and contact potential decision-makers after incapacity is determined, and allows health care providers to rely in good faith on decisions made under the act once incapacity is confirmed by two physicians.
The bill also sets standards for how decisions must be made, requiring the designated decision-maker and any probate court to act in the patient’s best interests and, when known and consistent with those interests, in accordance with the patient’s religious beliefs and preferences. It limits authority over nutrition and hydration, generally preferring natural feeding and allowing withdrawal of artificially supplied nutrition or hydration only under narrow medical conditions certified by two physicians. The act preserves the ability of interested persons to petition probate court for guardianship, addresses HIPAA access for the designated decision-maker, and includes protections for providers who make good-faith efforts to locate decision-makers.
SB 1536 would add a new statutory framework to chapter 404, RSMo, for appointing and recognizing a designated health care decision-maker for incapacitated patients. It would affect hospitals, nursing facilities, hospice providers, physicians, families, and probate courts by creating a default decision-making order, notice obligations, standards for incapacity and best interests, and limits on withholding or withdrawing treatment, including nutrition and hydration. The bill also interacts with existing guardianship law, durable powers of attorney for health care, HIPAA privacy rules, and Missouri provisions governing end-of-life care and pregnancy.
The available record shows the bill was referred to the Senate Families, Seniors and Health Committee and had only a first read, with no recorded votes or committee transcript excerpts. Based on the text, the bill appears to be framed as a patient-protection and family-decision-making measure, with strong emphasis on preserving life, preventing neglect, and ensuring that incapacitated patients are not denied care because of disability. The absence of recorded debate makes the overall legislative sentiment difficult to measure, but the structure of the bill suggests a generally supportive policy intent around clarifying decision-making authority and protecting vulnerable patients.
The main points of potential contention are who should have authority to make decisions, when that authority should be limited, and how to balance patient autonomy with life-preserving treatment. The bill gives priority to family members and certain close associates, but it also allows challenges in probate court, excludes alleged abusers or neglecters, and disqualifies persons who are unavailable or contrary to the patient’s clearly expressed wishes. Another likely area of debate is the bill’s restrictions on withdrawing artificially supplied nutrition and hydration, which may be viewed by supporters as a safeguard against premature death and by critics as limiting end-of-life choice. The pregnancy provision and the bill’s explicit rejection of euthanasia or mercy killing may also be points of disagreement for some stakeholders.