House Health Committee hears experts on model Uniform Healthcare Decisions Act

The House Health Committee convened an informational hearing on the Uniform Law Commission's 2023 Uniform Healthcare Decisions Act (UHDA), hearing testimony from legal experts, palliative clinicians, advocacy groups and disability-rights representatives about modernizing Pennsylvania's laws on advance directives, surrogate decision-making and capacity determinations.

Nina Cone, a law professor who served as reporter for the model act, told the committee the UHDA lowers execution barriers by allowing electronic forms and remote witnessing, clarifies when a surrogate may decide for a patient and sets a clear capacity standard. "Ultimately, the goal of this act is to ensure that people have a voice about their medical care even if they can't speak for themselves," Cone said, listing mental-health advance directives (so-called Ulysses clauses), an expanded default-surrogate list that includes domestic partners and cohabitants, and a plain-language model form.

Theresa Osborne, state advocacy director for AARP Pennsylvania, said the update reflects changes in medical practice and family structures and would reduce confusion when patients receive care across state lines. "The update ' reflects how families live and how health care is delivered today," Osborne said, urging broader public education and use of a standardized, plain-language form to reduce delays in honoring patients' wishes.

Caroline Doherty, a palliative-care nurse with decades of clinical experience, gave case examples showing why values-based directives are more useful at the bedside than checklists. She also noted interoperability and record-location problems: "Often they're buried somewhere in the chart, and they're not brought to the forefront," Doherty said, adding that clearer documentation and a way for agents to obtain records in advance would ease family-clinician communication.

In questions, Representative Venkat — who described his background as an emergency physician and clinical-ethics chair — asked how the model act would interact with actionable medical orders such as POLST or MOLST. Cone said the UHDA does not govern medical orders but helps translate an individual's instruction or agent's decision into clinical orders, and it sets a simple rule: the most recent valid instruction (medical order, written form, or oral instruction) governs.

Committee members pressed on capacity and dispute processes. Cone pointed to section 3, which differentiates capacity to make a health-care decision from the capacity to complete an advance directive or to appoint an agent and recognizes supported decision-making. If a patient objects to a finding of incapacity and seeks life-sustaining treatment, Cone said court oversight would be required before withdrawing such treatment; otherwise the act provides a process (including a second, disinterested medical opinion) to resolve disputes.

Disability Rights Pennsylvania's Jennifer Garman urged a presumption of capacity and training for clinicians so people with disabilities are not defaulted into guardianship. "All people with disabilities ' should be presumed capable of making decisions about their own lives with support when needed," she said, and she recommended implementation that emphasizes supported decision-making and less-restrictive alternatives.

Dr. Marion Grant, a certified palliative-care nurse practitioner, emphasized that most people never complete advance directives and that the UHDA's comprehensive framework could reduce conflict and delays at the bedside. "About two thirds of people do not complete these documents," Grant said, and she urged a prioritized default-surrogate list, stronger documentation protocols in electronic records, and training for clinicians alongside public outreach.

Committee members and witnesses discussed practical issues: allowing agents to obtain records before a capacity determination, using time-limited trials when prognosis is uncertain, and the cost contrast between guardianship (which can carry court fees and periodic reporting) and powers of attorney. Representative Bonner noted costs and urged encouraging advance directives as an alternative to costly guardianship proceedings.

Chair Frankel closed the hearing by thanking witnesses and staff and said the testimony will inform the committee's drafting process. "This is a very important discussion ' and it will be a major piece of legislation here in Pennsylvania," the chair said.

What's next: committee staff will use testimony from clinicians, legal experts, AARP and disability advocates as they continue drafting a state bill based on the UHDA; no formal vote or bill number was recorded during the hearing.