HB2535 is a comprehensive rewrite of Virginia’s existing Health Care Decisions Act. The bill repeals most of the current statutory framework in Article 8 of Title 54.1 and replaces it with a new Article 8.1, titled the Uniform Health Care Decisions Act. The new act modernizes and reorganizes the law governing advance health care directives, powers of attorney for health care, mental health advance directives, default surrogates, capacity determinations, revocation, and judicial review. It also updates related provisions across the Code to conform terminology and cross-references to the new act.
The bill expands and clarifies how individuals can plan for future medical decision-making. It defines capacity, establishes a presumption of capacity, sets procedures for finding incapacity, and creates a hierarchy of default surrogates when no agent is available. It also authorizes advance mental health care directives, allows electronic forms and signatures, recognizes copies of directives, and provides rules for co-agents and alternate agents. The bill further creates protections and remedies against falsifying, concealing, or coercing advance directives, and it preserves the ability of health care professionals and institutions to refuse care in limited conscience-based or legal-compliance circumstances while requiring transfer efforts and continued comfort care.
In addition to the new uniform act, HB2535 makes broad conforming amendments throughout health, mental health, guardianship, corrections, Medicaid, adult protective services, and records-disclosure statutes. These changes align existing laws with the new terminology and decision-making structure, including references to advance directives, agents, default surrogates, and the new article citation. The bill also updates related provisions on guardianship, involuntary treatment, psychiatric care, prisoner treatment, death and disposition of remains, and Medicaid application materials to reflect the new framework.
The bill’s impact on state law is substantial because it replaces a large portion of Virginia’s existing advance-directive law with a more detailed and modernized uniform scheme. It would affect patients, families, health care providers, hospitals, nursing homes, guardians, courts, and state agencies by changing how health care decisions are authorized, documented, challenged, and enforced. It also creates new civil penalties and causes of action for interference with advance directives and clarifies when providers must honor or may decline to honor directives or surrogate decisions.
The available legislative history suggests the bill faced caution or resistance early in the process. In subcommittee, it was recommended to be laid on the table by an 8-0 vote, which indicates unanimous reluctance at that stage rather than support. No committee transcript is available here, so the specific objections are not recorded, but the breadth of the rewrite and the bill’s effects on end-of-life decision-making, mental health directives, guardianship, and provider obligations likely made it a complex and potentially contentious proposal. The main points of contention would likely center on the scope of surrogate authority, the new rules for incapacity and revocation, the treatment of life-sustaining care, and the extent to which the bill overrides existing law.
HB2535 would repeal most of the current Health Care Decisions Act and replace it with a new Uniform Health Care Decisions Act in Title 54.1, while also amending numerous related statutes across health care, mental health, guardianship, corrections, Medicaid, and adult protective services. It would change the legal rules for advance directives, default surrogates, capacity findings, mental health directives, and provider duties, and would require conforming updates to cross-references and procedures throughout the Code of Virginia.
The most likely areas of contention are the bill’s broad replacement of existing end-of-life and health care decision statutes, the expanded authority given to default surrogates and agents, the standards for determining and challenging incapacity, and the interaction between patient directives and provider conscience or institutional policies. The bill also touches sensitive topics such as life-sustaining treatment, psychiatric admission, guardianship, and the handling of minors’ records, all of which could draw concern from health care providers, disability advocates, family members, and legal stakeholders.