Uniform Health Care Decisions Act draws strong praise and resistance; guardians and practitioners warn of unintended harms

Assembly Bill 461 would adopt the 2023 version of the Uniform Health Care Decisions Act, replacing Nevada’s older statutory framework for advance health care directives, capacity determinations and surrogate decision making with a modernized uniform text. Sponsor David Orentlicher and drafting reporter Professor Nina Cohn described the model law as the product of several years of national drafting and broad stakeholder input, including medical, nursing, palliative care, disability‑rights, and legal participants.

Supporters said the bill fixes longtime gaps in Nevada law about how to determine decision‑making capacity, how to treat advance directives created out of state, and how to identify a surrogate for a patient who did not appoint an agent. Professor Cohn said the Current Nevada statutes lack clear standards and leave providers and families without guidance in common scenarios where a patient’s capacity or a conflicting directive is at issue.

Key elements in the bill include a uniform capacity standard (under which a person is presumed to have capacity unless a court or qualified health care professional finds otherwise), recognition of oral, written and video instructions for future care, a default‑surrogate hierarchy for cases without an appointed agent, and good‑faith liability protection for health care professionals who follow a patient’s directive or a surrogate decision in good faith. The bill also preserves patients’ authority to appoint co‑agents and to set advance directives specifically for mental‑health care.

Opponents, which included the Guardianship Commission, the Nevada Psychiatric Association, senior legal services and several probate/estate attorneys, urged caution. They raised several recurring concerns: that the bill’s capacity standard and the categories of professionals permitted to override a presumption of capacity were too broad or vague; that the default surrogate provisions could be used by hospitals to bypass a patient’s named agent; and that the statute could invite litigation or reduce court supervision in cases where guardianship or judicial review is appropriate.

Steve Takas, an estate‑planning attorney, told the committee he feared the bill would send more disputes to court rather than reduce them, arguing the capacity standard could prompt challenges that require judicial resolution. The Guardianship Commission described possible due‑process problems and urged stricter protections for vulnerable adults. The Southern Nevada Senior Law Program and Legal Aid attorneys said the bill could hamper community clinics’ ability to execute simple advance directives at outreach events because it may impose additional documentation and capacity‑assessment obligations.

Professor Cohn and the sponsor responded that the act provides clearer, more consistent standards that will reduce uncertainty and the need for litigation once courts and providers adopt the uniform language. They said the bill allows for due process where a capacity finding is disputed — and that most routine cases would not require court involvement.

Committee members asked detailed questions about who may make capacity findings and about the safeguards for default surrogates; sponsors said they would continue technical discussions to refine training‑and‑availability language for professionals in rural areas and to address concerns about the interaction with guardianship statutes.

The committee closed the hearing. Sponsors and opponents committed to continued stakeholder negotiations on specific drafting issues before the bill would be scheduled for a work session or a vote.