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Bill would let patients name an immediate ‘trusted decision maker’ at point of care; backed by medical societies
Summary
House Bill 825 would let a patient designate a trusted decision maker to be recorded in the medical chart by a clinician if the patient has capacity but prefers a quicker, simpler proxy mechanism than a notarized advance directive or durable medical power of attorney.
Representative Cindy Cunningham introduced House Bill 825, which would allow an adult with decisional capacity to designate a “trusted decision maker” to make medical decisions should they lose capacity later in the same episode of care. The sponsor said the mechanism is intended as a practical, immediate tool when a patient is able to make a choice but has not completed a durable power of attorney or formal advance directive.
Medical organizations and practicing clinicians testified in favor. Jean Branscum of the Montana Medical Association called the bill a way “to fill a gap when…some decision making in advance of an accident or a medical crisis hasn't… been completed.” Colette Kirchhoff, a family and palliative medicine physician, said many patients never complete an advance directive (she cited national completion rates near 30%) and that a trusted decision maker helps ensure the patient’s wishes are known when they later lack capacity.
Supporters described how the process would work in practice: a clinician would document the patient’s name choice in the medical record while the patient still has decisional capacity. The bill specifies a decision‑maker hierarchy so that notarized durable medical power of attorney and formal advance directive designees remain primary; the trusted decision maker would apply where no formal proxy exists. Sponsor and clinician witnesses emphasized the policy is not intended to replace formal advance directives but to provide an immediate, accessible alternative for patients who lack a completed legal proxy and may be about to lose capacity.
Opponents were not recorded at the hearing. Committee members asked technical questions about safeguards and how the trusted decision maker would interact with existing documents; the sponsor and clinicians said the statute requires documentation in the chart and places the trusted decision maker below notarized proxies in precedence.
