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Missouri establishes surrogate health care decision-maker priority list for incapacitated patients
Original title: Establishes the Designated Health Care Decision-Maker Act, which authorizes certain persons to make health care decisions for certain incapacitated persons
Last action · April 8, 2026: SCS Voted Do Pass S Families, Seniors and Health Committee (6661S.02C)Sponsor: Rusty Black
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Introduced
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Floor Vote
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What This Bill Would Do
The Missouri Senate Committee Substitute for Senate Bill 1536 establishes the Designated Health Care Decision-Maker Act, creating a prioritized list of family members and close associates who can make medical decisions for patients lacking a formal power of attorney or guardian. Under the act, health care providers acting in good faith may rely on these designated decision-makers once two physicians certify the patient's incapacity. The law also establishes strict conditions for withdrawing and protects providers from liability during surrogate identification efforts.
Why it matters
Families of patients face a standardized legal framework for medical surrogate selection, establishing clear statutory priority from spouses down to close friends and religious members while prohibiting individuals with substantiated abuse reports from serving.
Who It Would Affect
Groups the bill's text would affect if enacted, as described in the record. Being affected is not a position for or against it.
Directly affected
Incapacitated patients
Their medical care and treatment decisions will be made by designated surrogates in order of statutory priority when they lack capacity.
Directly affected
Health care providers and facilities
They are granted legal protection from civil and criminal liability when relying in good faith on decisions made by designated surrogates.
Directly affected
Spouses and family members
They receive a formalized legal hierarchy and timeline to step in as surrogate decision-makers or challenge decisions in probate court.
Key Facts
- Establishes a strict priority list for surrogate medical decision-makers starting with spouses, followed by adult children, parents, adult siblings, grandparents or grandchildren, nieces/nephews or nearest relatives, religious community members, close nonrelatives, and persons unanimously agreed upon by the priority group.
- Requires two licensed physicians to determine and certify in writing that a patient is incapacitated before a designated health care decision-maker's authority begins.
- Requires the physician or their designee to make reasonable contact efforts using all known numbers within 24 hours of determining incapacity to inform potential decision-makers.
- Excludes individuals from serving as decision-makers if there is a substantiated mandatory report of abuse or neglect against them.
Show all 9 facts
- Prohibits designated health care decision-makers from authorizing the withdrawal of artificial nutrition or hydration with the intent to hasten death, allowing withdrawal only if two physicians certify it is unnecessary for comfort or cannot be physiologically tolerated.
- Grants designated health care decision-makers personal representative status under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) to access private medical information.
- Protects health care providers and facilities from civil or criminal liability when making good faith and reasonable attempts to identify and communicate with potential decision-makers.
- Allows any interested person, provider, or facility to petition the probate court for a temporary or permanent guardian if there is disagreement regarding patient care.
- Prohibits withholding or withdrawing life-sustaining health care, nutrition, or hydration while probate court proceedings regarding a guardian are pending, if doing so would result in or hasten death or jeopardize health.
Frequently Asked Questions
Who is authorized to make medical decisions if a patient is incapacitated and has no power of attorney?
A designated health care decision-maker chosen from a prioritized list set by law, starting with the patient's spouse, then adult children, parents, adult siblings, grandparents, grandchildren, other relatives, religious community members, or close nonrelatives.
Can any family member automatically make medical decisions for an incapacitated patient?
No. Two licensed physicians must first determine and certify that the patient is , and individuals with substantiated reports of abuse or neglect against the patient are disqualified from serving.
Under what conditions can artificial nutrition or hydration be withdrawn?
Two physicians must certify in the medical record that artificial nutrition or hydration is not necessary for comfort, care, or pain relief and would only artificially prolong the dying process, or that it cannot be physiologically assimilated or tolerated by the patient.
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Votes, people, money & the original sourceWhere This Stands
Currently in committee. The next step in the legislative lifecycle is Floor Vote.
Procedural history
4 actions- Apr 8, 2026SenateCommitteeSCS Voted Do Pass S Families, Seniors and Health Committee (6661S.02C)
- Mar 25, 2026SenateHearing Conducted S Families, Seniors and Health Committee
- Feb 5, 2026SenateFloorSecond Read and Referred S Families, Seniors and Health Committee
- Jan 12, 2026SenateIntroducedS First Read
Version history & redline
2 versions on fileComparing 6661S.01I - Introduced → Senate Committee Substitute - Committee Version
removed addedOfficial text
removed: SECOND REGULAR SESSION
added: 6661S.02C
1
SENATE added: COMMITTEE SUBSTITUTE
FOR
SENATE BILL NO. 1536
removed: 103RD GENERAL ASSEMBLY
INTRODUCED BY SENATOR BLACK.
6661S.01I KRISTINA MARTIN, Secretary
AN ACT
To amend chapter 404, RSMo, by adding thereto removed: eleven added: ten new sections relating to the appointment
of a designated health care decision-maker.
Be it enacted by the General Assembly of the State of Missouri, as follows:
Section A. Chapter 404, RSMo, is amended by adding thereto removed: eleven added: ten new sections, to be known as sections 404.1100, 404.1101, 404.1102, 404.1103, 404.1104, 404.1105, 404.1106, 404.1107, removed: 404.1108, 404.1109, and 404.1110, to read as follows: 404.1100. Sections 404.1100 to 404.1110 shall be known and may be cited as the "Designated Health Care
[…]
same range, quality, and standard of health care, care, and comfort as is provided to a similarly situated individual who is not incapacitated; and added: 2
(c) Advocating against the discriminatory denial of health care, care, or comfort, or food or fluids added: solely on the basis that the person who is incapacitated is considered an individual with a disability; (3) "Designated health care decision-maker", the person designated
[…]
facility, dialysis treatment facility, assisted living facility, or home health or hospice agency; any entity that provides home or community-based health care services; or added: 3
any other facility that provides or contracts to provide health care, and that is licensed, certified, or otherwise authorized or permitted by law to
[…]
or health care facility may rely on the exercise of good faith and in accordance with reasonable medical judgment upon the health care decisions added: 4
made for a patient by a designated health care decision- maker selected in accordance with removed: section added: sections 404.1103 and
404.1104, provided that two licensed physicians determine, after reasonable inquiry and in accordance with reasonable medical judgment, that such patient is removed: incapacitated and has neither a guardian with medical decision-making authority appointed in accordance with chapter 475, an attorney in fact appointed in a durable power of attorney for health care in accordance with sections 404.800 to 404.865, is not a child under the jurisdiction of the juvenile court under section 211.031, nor any other known person who has the legal authority to make health care decisions. added: incapacitated.
404.1103. Upon a determination that a patient is incapacitated, the removed: physician added: physician, or removed: another health care provider added: the physician's designee
acting at the direction of the removed: physician added: physician, shall make reasonable efforts to inform potential designated health care decision-makers set forth in section 404.1104 of whom the physician or the physician's designee
[…]
is unable to provide consent regarding his or her own health care, and does not have a legally appointed guardian or an agent under added: 5
a health care durable power of attorney, is not under the jurisdiction of the juvenile court, or does not have any other person who
[…]
religious life, who conducts or assists in the conducting of religious services, and who actually and regularly engages in religious, benevolent, charitable, or educational removed: ministry added: ministry,
or the performance of health care services; (8) Any nonrelative who can demonstrate that he or she has a close personal relationship with the patient and is familiar with the patient's personal values; or added: 6
(9) Any other person designated by the unanimous mutual agreement of the persons listed above who is involved in the patient's care. 2. If
[…]
subsection 1 of this section, regardless of priority, or a health care provider or a health care facility involved in the care of the removed: patient added: patient, disagrees on whether certain health care should be provided to or withheld or withdrawn from a patient, any such person, provider, or facility, or
[…]
guardian under subsection 8 of this section to act in the best interests of the patient. 4. Priority under this section shall not be added: knowingly
given to persons in any of the following circumstances: (1) If a report of abuse or neglect of the patient has been made pursuant
[…]
abuse or neglect, then unless the report has been determined to be unsubstantiated or unfounded, or a determination of abuse was finally reversed after added: 7
administrative or judicial review, the person reported as the alleged perpetrator of the abuse or neglect shall not be given priority or authority to
[…]
reasonable efforts to obtain information regarding the patient's health care preferences from health care providers, family, friends, or others who may have credible information. added: 8
(2) The designated health care decision-maker, and the probate court in any proceeding under subsection 8 of this section, shall always make health care
[…]
facility involved in the care of the patient, from petitioning the probate court for the appointment of a temporary or permanent guardian for the added: 9
patient including expedited adjudication as provided in chapter 475. 9. Pending the final outcome of proceedings initiated under subsection 8 of this section, the
[…]
death of the patient, would jeopardize the health or limb of the patient, or would result in disfigurement or impairment of the patient's faculties. removed: If a health care provider or a health care facility objects to the provision of such health care, nutrition, or hydration on the basis of religious beliefs or sincerely held moral convictions, the provider or facility shall not impede the transfer of the patient to another health care provider or health care facility willing to provide it, and shall provide such health care, nutrition, or hydration to the patient pending the completion of the transfer. For purposes of this section, artificially supplied nutrition and hydration may be withheld or withdrawn during the pendency of the guardianship proceeding only if, based on reasonable medical judgment, the patient's physician and a second licensed physician certify that the patient meets the standard set forth in subdivision (2) of subsection 1 of section 404.1105. removed: If tolerated by the patient and adequate to supply the patient's needs for nutrition or hydration, natural feeding shall be the preferred method. 404.1105. 1. No designated health care decision-maker may, with the intent of hastening or causing the death of the patient, authorize the withdrawal or withholding
[…]
2. When tolerated by the patient and adequate to supply the patient's need for nutrition or hydration, natural feeding shall be the preferred method. added: 10
3. The provisions of this section shall not apply to subdivision (3) of section 459.010. 404.1106. If any of the individuals specified in section
[…]
subject to civil or criminal liability or regulatory sanction for the effort to identify, locate, and communicate with such potential designated health care decision-makers. removed: 404.1108. 1. A health care provider or a health care facility may decline to comply with the health care decision of a patient or a designated health care decision-maker if such decision is contrary to the religious beliefs or sincerely held moral convictions of a health care provider or health care facility. 2. If at any time, a health care provider or health care facility determines that any known or anticipated health care preferences expressed by the patient to the health care provider or health care facility, or as expressed through the patient's designated health care decision-maker, are contrary to the religious beliefs or sincerely held moral convictions of the health care provider or health care facility, such provider or facility shall promptly inform the patient or the patient's designated health care decision-maker. 3. If a health care provider declines to comply with such health care decision, no health care provider or health care facility shall impede the transfer of the patient to another health care provider or health care facility willing to comply with the health care decision. 4. Nothing in this section shall relieve or exonerate a health care provider or a health care facility from the duty to provide for the health care, care, and comfort of a patient pending transfer under this section. If withholding or withdrawing certain health care would, in reasonable medical judgment, result in or hasten the death of the patient, such health care shall be provided pending completion of the transfer. Notwithstanding any other provision of this section to the contrary, no such health care shall be denied on the basis of a view that treats extending the life of an elderly, disabled, or terminally ill individual as of lower value than extending the life of an individual who is younger, nondisabled, or not terminally ill, or on the basis of the health care provider's or facility's disagreement with how the patient or individual authorized to act on the patient's behalf values the tradeoff between extending the length of the patient's life and the risk of disability. 404.1109. No designated health care decision-maker shall withhold or withdraw health care from a pregnant patient, consistent with existing law, as set forth in section 459.025. 404.1110. Nothing in sections 404.1100 to 404.1110 is intended to: (1) Be construed as condoning, authorizing, or approving euthanasia or mercy killing; or added: 11
(2) Be construed as permitting any affirmative or deliberate act to end a person's life, except to permit natural death as provided by sections 404.1100 to 404.1110.
Redline computed from the official version text (record lane).View this version →
Lobbying Activity
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Full breakdown
Who this bill affects and the strongest case for and against it, written only from the bill’s own text.
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Open source document
www.senate.mo.gov
Analysis Score
0–100- Significance75How much this matters to a regular citizen
- Controversy40Intensity of disagreement among stakeholders
- Entertainment5Compellingness for a non-policy-wonk reader
- Buzz25Current news / social attention level
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