Summary — HB 4418 (2025): Surrogate Decision Makers for Health Care
Status (selected)
- Introduced: March 11 / May 1, 2025 (Rep. Jamie Thompson)
- Substitute (H-2) adopted; passed House (with immediate effect) Sept. 18, 2025 (98–0)
- Transmitted and referred to Committee on Civil Rights, Judiciary, and Public Safety (Sept. 22, 2025)
- Tie-bar: HB 4419 (2025). Companion Senate bill: SB 2105.
Purpose
- Adds Part 6 (“Surrogate Decision Makers for Health Care”) to Article V of the Estates and Protected Individuals Code (EPIC) to authorize non‑advocate, non‑guardian surrogates to make health care decisions for adults and emancipated minors under specified circumstances. Also repeals section 66h of 1939 PA 280 (MCL 400.66h).
Key definitions (selected)
- “Surrogate”: an individual, other than a patient advocate or guardian, authorized under EPIC to make a health care decision.
- “Health care decision”: decisions about selection/discharge of providers or facilities, approval/disapproval of diagnostic tests, and directions to provide or withhold forms of health care — except where the patient’s wishes must be shown by clear and convincing evidence (section 5509 standard) or when patient surrogate authority under Public Health Code Part 56A applies.
- “Reasonably available”: readily contactable without undue effort and able to act timely (including in person, by phone, video, etc.).
Designation and priority
- An adult or emancipated minor admitted to a health care facility may designate a surrogate in writing; the designation must be placed in the medical record. If not in writing, the designation can be communicated to an attending health professional but requires a witness (in addition to the professional) and written entry in the record.
- If no designation (or patient advocate/guardian is unavailable), EPIC establishes a prioritized list of who may act as surrogate (examples: existing guardian, durable power of attorney as attorney‑in‑fact; then spouse, adult child, domestic partner, parent, sibling, long‑term roommate, caregiver nominee, or other adult familiar with patient’s values).
Authority, limitations, and safeguards
- A surrogate may act only when: (1) the patient (adult or emancipated minor) is incapable of participating in the decision (per section 5508 standard), and (2) there is no patient advocate designation/out‑of‑state equivalent or guardian available after documented attempts.
- Surrogate authority is suspended when the patient regains decision‑making ability.
- Surrogates must sign an acceptance of authority to be placed in the medical record. Required statements include (among others):
- No authority to make decisions the patient could not make.
- No authority to withhold/withdraw treatment if that decision would result in the patient’s death.
- No compensation for serving; reimbursement allowed for necessary expenses.
- Duty to act as a fiduciary and in the patient’s best interests; known patient wishes are presumed part of best interest.
- A surrogate must visit the patient and be given access by facility staff; must notify readily contactable family as soon as practicable.
- Disqualifications: persons subject to personal protection orders or pending criminal actions for vulnerable adult abuse/domestic violence; courts may disqualify by preponderance of evidence. A patient may disqualify a person from serving (written or witnessed verbal/nonverbal communication), effective even if later found to lack capacity.
Recordkeeping and procedural requirements
- Designations, acceptance of authority, revocations, disqualifications, and changes in surrogate must be documented in the patient’s medical record.
- If a higher‑priority individual becomes available, they supplant the current surrogate and the change must be documented.
Who is affected
- Patients (adults and emancipated minors) admitted to health care facilities, their families and potential surrogates, patient advocates and guardians, hospitals and other health facilities (recordkeeping, visitation/access duties), and health professionals who document designations and witnesses.
Potential impacts
- Creates a clear statutory process for involving family members or other close persons in medical decision‑making when no patient advocate or guardian is available.
- Imposes documentation, witness, and access obligations on health care providers/facilities.
- Limits surrogate authority on end‑of‑life withdrawal/withholding decisions and includes safeguards (disqualifications, court review, fiduciary duties).
- May increase administrative responsibilities for hospitals (medical record entries, witness verification, verifying priority, notifying family).
Relevant law references
- Amends 1998 PA 386 (EPIC), adding Part 6 to Article V (MCL 700.1101–700.8206).
- Cross‑references and standards rely on EPIC sections 5508–5509 and Public Health Code Part 56A (MCL 333.5651–333.5661).
