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HD 3290

An Act improving medical decision making

194th Legislature (2025-2026) Introduced by Christopher Markey

The act creates a formal, court-free surrogate decision-making pathway to timely decide medical care for incapacitated adults who lack a proxy or guardian, reflecting known wishes

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Bill Summary · HD 3290

Summary: An Act improving medical decision making (HD 3290)

Overview

This Massachusetts bill seeks to ensure timely medical decision-making for adults who lack decisional capacity and do not have a valid advance directive or guardian. It creates a formal process to designate a surrogate decision-maker to act on behalf of incapacitated individuals, with the goal of aligning decisions with the patient’s preferences and values while avoiding court intervention.

  • Bill: HD 3290 (An Act improving medical decision making)
  • Introduced: 2025 (House Docket No. 3290; filed January 17, 2025; previously similar matter in 2023-24)
  • Sponsor: Rep. Christopher M. Markey
  • Relationship to existing tools: Does not override valid health care proxies or MOLST forms; provides a parallel surrogate pathway when no directive or guardian is available.

Purpose and intent

  • Recognize the adult patient’s right to determine health care, while acknowledging that not everyone completes advance directives.
  • Establish a streamlined surrogate decision-making process to be used “in a timely manner” without court action when there is no valid proxy or guardian.
  • Ensure decisions reflect the patient’s values, beliefs, and likely wishes, or, if unknown, the patient’s best interests.

Key provisions

Surrogate decision-making framework

  • Adds new Section 18 (Surrogacy) to Chapter 201D.
  • Applicability: Applies to incapacitated persons who lack a valid health care proxy or MOLST that covers the decision at issue.
  • Comparisons to existing tools: If a health care proxy or MOLST is operative and applicable, those instruments control.

Authority and scope

  • A surrogate may make medical decisions, including transfers or admissions to nursing facilities, but not admissions to inpatient mental health facilities.
  • Decisions must be made in accordance with the person’s preferences and values, considering ethical beliefs and prior expressed wishes.
  • If the person’s wishes are unknown, decisions are based on the person’s best interests, weighing burdens and benefits of treatment versus non-treatment, and considering input from family and friends.

Decision-maker prioritization

  • Surrogates are chosen in an order of priority (as referenced to Section 9) and must consult with the attending physician.
  • If no valid directives exist and no surrogate is available, surrogate decision-making proceeds under this act.

Capacity and determination

  • A physician determines incapacity by evaluating understanding of treatment, ability to express preferences, and may consult medical records, care staff, and family.
  • A reasonable inquiry is required to identify potential surrogates when incapacity arises.

Definitions (new or clarified)

  • Available vs. unavailable: Defines conditions under which a person can be contacted or deemed unavailable.
  • Attending physician: The physician primarily responsible for treatment, or the most appropriate among multiple physicians.
  • Incapacitated person: Someone unable to understand treatment risks/benefits or express a treatment preference.
  • Qualified individual: An adult familiar with the patient’s values, reasonably available, and willing to serve.

Who is affected

  • Incapacitated adults lacking advance directives or guardians.
  • Families, friends, and other potential surrogates who may serve in the decision-making role.
  • Health care providers tasked with determining capacity and implementing surrogate decisions.

Procedural and timeline aspects

  • Quick identification and appointment of a surrogate intend to avoid court processes.
  • Coordination with attending physicians to ensure timely decisions.
  • Requires documentation and evidence of best interests when wishes are unknown.

Potential impact

  • Improves timeliness of crucial care decisions for incapacitated patients.
  • Provides a clear statutory pathway short of guardianship or court action.
  • Balances patient autonomy with protective decision-making when the patient’s preferences are not documented.

Compiled from official sources — confirm details with the bill’s official record.

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