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Bills would create next‑of‑kin surrogate medical decision process; backers say law would reduce guardianship filings
Summary
Representative Thompson and supporters told the House Judiciary Committee that House Bills 4418 and 4419 would establish a prioritized next‑of‑kin surrogate decision maker for medical decisions when an adult lacks a patient advocate designation, aiming to reduce short‑term guardianship petitions and preserve family time at end of life.
Representative Thompson presented House Bills 4418 and 4419 and described the bills as personal and aimed at clarifying who may make medical decisions when an adult loses capacity and has not executed a patient advocate designation. "These bills create a prioritized list of individuals who can serve as next of kin or surrogate decision maker in a medical crisis," Representative Thompson said, describing her own experience with her father's end of life care as motivating the measure.
Nicole Shannon, an attorney with the Michigan Elder Justice Initiative, told the committee Michigan is one of more than 30 states that currently do not automatically allow next of kin to make medical decisions and said the absence of a statutory default forces families and hospitals into the guardianship process. She explained the bill's mechanics: when a patient lacks capacity and has no patient advocate designation, a prioritized list of relatives would have authority equivalent to a basic patient advocate agent for immediate medical decisions; if multiple people occupy the same priority level (for example, three siblings), they would select one spokesperson to act for the patient during the acute episode.
Elizabeth Cutter (identified in the hearing as representing Michigan Health and Hospitals) supported the bills and said the measure would help hospitals by aligning the process for establishing who may make medical decisions without requiring staff to differentiate among competing legal standards.
Genevieve Martin, legislative director and senior policy adviser for Right to Life of Michigan, said Right to Life had worked on related laws for decades and supported the bills while offering drafting suggestions. Martin urged a technical change for court language: she recommended replacing a provision that allows courts to "appoint a surrogate" in disputes with language authorizing appointment of a guardian, temporary guardian or emergency guardian because, she said, courts currently lack a rubric for appointing a "surrogate" under the bill's text. Martin also called attention to an enacting-section line in the draft that would repeal "MCL 466h" and said that appears to repeal a core requirement that medical personnel obtain consent before treatment; she recommended revising rather than wholesale repealing that provision.
Supporters emphasized safeguards and limits. Nicole Shannon said the next‑of‑kin surrogate would have authority comparable to a basic patient advocate agent: it would not include authority to stop life‑sustaining treatment or to consent to certain mental‑health treatments. The bill uses Michigan's existing capacity standard (typically two clinicians making a determination) and would terminate surrogate authority once the patient regains capacity, supporters said.
Several organizations submitted written support: Michigan Health and Hospitals (submitted speaker), Michigan Elder Justice Initiative, Right to Life of Michigan, Disability Rights of Michigan and HCAM (all recorded as supporting and not speaking). Committee members did not ask questions at the hearing, and the committee did not take a formal vote on the bills that day.
