The State of Regulation on Alternate Decision Makers: A Review of 51 Statutes

April 21, 2017 | Aging Services Risk, Quality, & Safety Guidance

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​Statutes that shape clinical decision making for incapacitated individuals vary widely among the 50 states and the District of Columbia, found the authors of a regulatory analysis in the New England Journal of Medicine. The analysis was undertaken to discern how decisions regarding the care of incapacitated residents or patients may occur in different jurisdictions. The authors evaluated statutory language describing who can act as "alternate decision makers" as well as the hierarchical treatment of potential alternate decision makers in each jurisdiction and proposed solutions to disputes that could arise among interested parties. They found that all 50 states and the District of Columbia have laws that address medical decision making for those who are unable to make their own medical decisions—but uniformity ends there.

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