Healthcare providers mandated to select best qualified surrogate decision makers

On April 18, 2025, the Commonwealth of Massachusetts introduced House Bill 1692, a significant piece of legislation aimed at reforming the process of surrogate decision-making for incapacitated individuals. The bill seeks to address the complexities and challenges faced by healthcare providers and families when determining who should make medical decisions on behalf of patients unable to do so themselves.

The primary purpose of House Bill 1692 is to establish clear criteria for selecting surrogate decision-makers, particularly when multiple individuals are eligible at the same priority level. Key provisions of the bill outline a structured approach for attending physicians to evaluate potential surrogates based on their ability to make decisions aligned with the incapacitated person's wishes or best interests. Factors such as the surrogate's prior relationship with the patient, their demonstrated care, and their availability for communication with healthcare providers are emphasized.

Notably, the bill allows attending physicians the discretion to appoint a surrogate who may rank lower in priority if they are deemed better qualified based on the outlined criteria. This flexibility aims to ensure that the most suitable individual is chosen to represent the patient's interests, even if they do not fit the traditional hierarchy of surrogate decision-makers.

Debate surrounding House Bill 1692 has focused on the balance between maintaining a structured decision-making hierarchy and allowing for flexibility in unique circumstances. Supporters argue that the bill enhances patient autonomy and ensures that decisions are made by those who truly understand the patient's values and preferences. Critics, however, express concerns about the potential for subjective judgments by physicians, which could lead to inconsistencies in decision-making.

The implications of this legislation are significant, as it addresses a critical gap in current healthcare practices regarding incapacitated patients. Experts suggest that by clarifying the surrogate selection process, the bill could reduce conflicts among family members and improve the quality of care for patients during vulnerable times.

As House Bill 1692 moves through the legislative process, its potential to reshape surrogate decision-making in Massachusetts healthcare settings remains a focal point of discussion among lawmakers, healthcare professionals, and advocates for patient rights. The outcome of this bill could set a precedent for similar legislation in other states, highlighting the importance of thoughtful and compassionate decision-making in healthcare.