Family Health Care Decisions Act Summary
The Family Health Care Decisions Act establishes the authority of a patient’s family member or close friend to make health care decisions for the patient in cases where a patient lacks decisional capacity and did not leave prior instructions or appoint a health care agent. The family member or close friend’s decision making authority would include the authority to direct the withdrawal or withholding of life-sustaining treatment when standards set forth in the statute are satisfied.
Until this legislation was signed into law by Governor Paterson on March 16, 2010, in general,
unless there was a health care agent appointed pursuant to a completed health care proxy form,
there was no legal basis for a family member or friend to make health or end-of-life decisions on
behalf of the patient who lacked decision making capacity. Instead, decisions to withdraw or
withhold treatment could be made only where there was “clear and convincing evidence” of the
patient’s wish to refuse such treatment. Moreover, when a patient lacked capacity, family
members lacked clear authority even to consent to beneficial, desired treatment. While health
care providers routinely, and out of necessity, accepted treatment consent from a family member
or close friend for beneficial treatment, there was only thin legal support in New York for that
practice.
Summary of Key Provisions of the FHCDA
1. Applicability
Applies to decisions in general hospitals and residential health care facilities. The
term “hospital” is used to apply to these two settings.
Does not apply to decisions for patients:
− who have a health care agent or who have left prior treatment instructions.
− who have a court-appointed guardian.
− for whom decisions about life-sustaining treatment may be made pursuant to OMH or
OPWDD surrogate decision making regulations.
2. Determining Incapacity
Sets forth a hospital-based process to determine that a patient lacks decisional
capacity. In general, the process requires an initial determination by the attending
physician, and may require a concurring determination by a “health or social services
practitioner,” a broader category of professionals.
Requires special credentials for professionals when determining that the patient lacks
capacity as a result of mental retardation or mental illness.
Provides that if the patient objects to the determination of incapacity, or to the choice
of a surrogate, or to a surrogate’s decisions, the patient’s decisions prevails unless a
court finds that the patient lacks capacity, or another legal basis exists for overriding
the patient’s decision.
3. Decisions for Patients who Lack Capacity
• Sets forth, in order of priority, the persons who may act as a surrogate decision maker
for the incapable patient, i.e.:
- an MHL Article 81 court-appointed guardian (if there is one);
- the spouse or domestic partner
- an adult son or daughter
- a parent
- a brother or sister
- a close friend (who could be another relative)
Grants the surrogate the right to receive medical information and medical records necessary to
make informed decisions about the patient’s health care, including diagnosis, prognosis and risks
and benefits of alternative treatment options.
Grants the surrogate authority to make all health care decisions for the patient that the
adult patient could make for himself or herself, subject to certain standards and
limitations.
States that health care providers do not need a surrogate’s consent for a health care
decision if the patient previously made the decision, either orally or in writing.
Requires the surrogate to decide about treatment based on the patient’s wishes, including
the patient’s religious and moral beliefs, or, if the patient’s wishes are not reasonably
known and cannot with reasonable diligence be ascertained, based on the best interests.
Authorizes decisions to withhold or withdraw life-sustaining treatment if treatment would
be an extraordinary burden to the patient and the patient is terminally ill or permanently
unconscious, or if the patient has an irreversible or incurable condition and the treatment
would involve such pain, suffering or other burden that it would reasonably be deemed
inhumane or an extraordinary burden under the circumstances. Certain such decisions
require ethics committee review.
Authorizes the parent or guardian of a minor patient to decide about life-sustaining
treatment, in accord with the same standards that apply to surrogate decisions for adults.
In addition, if a minor has the capacity to decide about life-sustaining treatment, the
minor’s consent is required to withhold or to stop treatment.
Establishes a procedure for making health care decisions, other than life-sustaining
treatment decisions, for adult patients who have lost decision-making capacity and have
no available family member or friend to act as a surrogate.