1.1 A bill for an act
1.2 relating to civil law; creating default surrogate for health decisions and providing
1.3 a process to appoint default surrogate for health decisions; amending Minnesota
1.4 Statutes 2024, sections 145C.01, subdivision 2, by adding subdivisions; 145C.03,
1.5 by adding a subdivision; 145C.10; 145C.11; proposing coding for new law in
1.6 Minnesota Statutes, chapter 145C.
1.7BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.8 Section 1. Minnesota Statutes 2024, section 145C.01, is amended by adding a subdivision
1.9to read:
1.10 Subd. 1c.Default surrogate for health decisions.A physician, advanced practice
1.11registered nurse, or physician assistant shall not recognize a default surrogate for health
1.12decisions unless the individual for whom a health care decision is necessary is an
1.13unrepresented individual as defined in subdivision 10. "Default surrogate for health decisions"
1.14means either an individual or individuals age 18 or older, or an organization, so long as the
1.15individual, individuals, or organization is one of the following:
1.16 (1) an individual or individuals included in the unrepresented individual's kinship system;
1.17 (2) a friend or more than one friend of the unrepresented individual;
1.18 (3) a health care agent appointed by the unrepresented individual in a health care directive
1.19that does not include a designation of the power necessary to make the health care decision
1.20for which the physician, advanced practice registered nurse, or physician assistant seeks
1.21informed consent;
1Section 1.
25-03817 as introduced03/10/25 REVISOR SGS/LJ
SENATE
STATE OF MINNESOTA
S.F. No. 2567NINETY-FOURTH SESSION
(SENATE AUTHORS: MANN)
OFFICIAL STATUSD-PGDATE
Introduction and first reading03/13/2025
Referred to Judiciary and Public Safety 2.1 (4) other individual or individuals designated in writing or verbally by the unrepresented
2.2individual or who are qualified or registered to assist the unrepresented individual in other
2.3respects, including but not limited to:
2.4 (i) a designated representative pursuant to section 144G.08, subdivision 19;
2.5 (ii) a client representative pursuant to section 144A.43, subdivision 1e;
2.6 (iii) a hospice patient's family pursuant to section 144A.75, subdivision 7;
2.7 (iv) an individual under section 144.651, subdivision 10;
2.8 (v) a responsible party pursuant to section 144.6501, subdivision 1, paragraph (e);
2.9 (vi) an individual appointed by the unrepresented individual in a valid power of attorney
2.10pursuant to chapter 523; and
2.11 (vii) a representative payee with respect to governmental benefits; or
2.12 (5) a professional or other individuals supportive of the unrepresented individual such
2.13as:
2.14 (i) clergy and religious order members;
2.15 (ii) care managers;
2.16 (iii) professional advocates;
2.17 (iv) supporters consistent with the definition of supported decision making in section
2.18524.5-102, subdivision 16a; and
2.19 (v) individuals associated with a health care agent organization.
2.20 Sec. 2. Minnesota Statutes 2024, section 145C.01, is amended by adding a subdivision to
2.21read:
2.22 Subd. 1d.Friends."Friends" means adults who exhibit good faith concern for the
2.23unrepresented individual and who are familiar with and supportive of the unrepresented
2.24individual.
2.25 Sec. 3. Minnesota Statutes 2024, section 145C.01, subdivision 2, is amended to read:
2.26 Subd. 2.Health care agent."Health care agent" means an individual age 18 or older
2.27who is or a health care agent organization appointed by a principal in a health care power
2.28of attorney to make health care decisions on behalf of the principal. "Health care agent"
2.29may also be referred to as "agent."
2Sec. 3.
25-03817 as introduced03/10/25 REVISOR SGS/LJ 3.1 Sec. 4. Minnesota Statutes 2024, section 145C.01, is amended by adding a subdivision to
3.2read:
3.3 Subd. 2a.Health care agent organization."Health care agent organization" means an
3.4organization that maintains a group of individuals who are reasonably available to serve as
3.5health care agents pursuant to this chapter.
3.6 Sec. 5. Minnesota Statutes 2024, section 145C.01, is amended by adding a subdivision to
3.7read:
3.8 Subd. 7b.Kinship system."Kinship system" means a system of social relationships
3.9connecting people in a community or culture who are, or are held to be, related, and which
3.10defines and regulates the reciprocal obligations within the system, such as family members,
3.11religious communities, and ethnic communities.
3.12 Sec. 6. Minnesota Statutes 2024, section 145C.01, is amended by adding a subdivision to
3.13read:
3.14 Subd. 10.Unrepresented individual."Unrepresented individual" means an individual
3.15age 18 or older who:
3.16 (1) has not previously executed a health care directive containing health care instructions
3.17or appointing a health care agent;
3.18 (2) has previously executed a health care directive appointing a health care agent but
3.19the individual has revoked the health care power of attorney under section 145C.09, or has
3.20appointed a health care agent who is not reasonably available, or who has not given the
3.21health care agent in the reasonable professional judgment of the physician, advanced practice
3.22registered nurse, or physician assistant the powers that are necessary to make the health
3.23care decision for which the physician, advanced practice registered nurse, or physician
3.24assistant seeks informed consent;
3.25 (3) has previously executed a health care directive containing health care instructions
3.26which did not appoint a health care agent but has revoked the health care directive under
3.27section 145C.09, or has provided health care instructions insufficient in the reasonable
3.28professional judgment of the physician, advanced practice registered nurse, or physician
3.29assistant to permit the physician, advanced practice registered nurse, or physician assistant
3.30to act; or
3.31 (4) is not currently subject to a guardianship in which the power to make health care
3.32decisions has been granted pursuant to section 524.5-313, paragraph (c).
3Sec. 6.
25-03817 as introduced03/10/25 REVISOR SGS/LJ 4.1 Sec. 7. Minnesota Statutes 2024, section 145C.03, is amended by adding a subdivision to
4.2read:
4.3 Subd. 4.Health care agent organization appointed as agent.If the principal executes
4.4a health care power of attorney appointing a health care agent organization as the principal's
4.5health care agent, the health care power of attorney shall include the name, address, telephone
4.6number, and email address of the health care agent organization, and the name of at least
4.7one individual associated with the health care agent organization designated by the principal
4.8to act as agent on behalf of the health care agent organization. The health care agent
4.9organization may designate a successor agent or agents if the initial agent is not reasonably
4.10available at the time the health care power of attorney becomes effective pursuant to section
4.11145C.06.
4.12 Sec. 8. Minnesota Statutes 2024, section 145C.10, is amended to read:
4.13 145C.10 PRESUMPTIONS.
4.14 (a) The principal is presumed to have the capacity to execute a health care directive and
4.15to revoke a health care directive, absent clear and convincing evidence to the contrary.
4.16 (b) A health care provider or health care agent may presume that a health care directive
4.17is legally sufficient absent actual knowledge to the contrary. A health care directive is
4.18presumed to be properly executed, absent clear and convincing evidence to the contrary.
4.19 (c) A health care agent or default surrogate for health decisions, and a health care provider
4.20acting pursuant to the direction of a health care agent or default surrogate for health decisions,
4.21are presumed to be acting in good faith, absent clear and convincing evidence to the contrary.
4.22 (d) A health care directive is presumed to remain in effect until the principal modifies
4.23or revokes it, absent clear and convincing evidence to the contrary.
4.24 (e) This chapter does not create a presumption concerning the intention of an individual
4.25who has not executed a health care directive and, except as otherwise provided by section
4.26145C.15, does not impair or supersede any right or responsibility of an individual to consent,
4.27refuse to consent, or withdraw consent to health care on behalf of another in the absence of
4.28a health care directive, including but not limited to a default surrogate for health decisions.
4.29 (f) A copy of a health care directive is presumed to be a true and accurate copy of the
4.30executed original, absent clear and convincing evidence to the contrary, and must be given
4.31the same effect as an original.
4Sec. 8.
25-03817 as introduced03/10/25 REVISOR SGS/LJ 5.1 (g) When a patient lacks decision-making capacity and is pregnant, and in reasonable
5.2medical judgment there is a real possibility that if health care to sustain her life and the life
5.3of the fetus is provided the fetus could survive to the point of live birth, the health care
5.4provider shall presume that the patient would have wanted such health care to be provided,
5.5even if the withholding or withdrawal of such health care would be authorized were she not
5.6pregnant. This presumption is negated by health care directive provisions described in
5.7section 145C.05, subdivision 2, paragraph (a), clause (10), that are to the contrary, or, in
5.8the absence of such provisions, by clear and convincing evidence that the patient's wishes,
5.9while competent, were to the contrary.
5.10 Sec. 9. Minnesota Statutes 2024, section 145C.11, is amended to read:
5.11 145C.11 IMMUNITIES.
5.12 Subdivision 1.Health care agent and default surrogate for health decisions.A health
5.13care agent or default surrogate for health decisions is not subject to criminal prosecution or
5.14civil liability if the health care agent acts in good faith.
5.15 Subd. 2.Health care provider.(a) With respect to health care provided to a patient
5.16with a health care directive, a health care provider is not subject to criminal prosecution,
5.17civil liability, or professional disciplinary action if the health care provider acts in good
5.18faith and in accordance with applicable standards of care.
5.19 (b) A health care provider is not subject to criminal prosecution, civil liability, or
5.20professional disciplinary action if the health care provider relies on a health care decision
5.21made by the health care agent and the following requirements are satisfied:
5.22 (1) the health care provider believes in good faith that the decision was made by a health
5.23care agent appointed to make the decision and has no actual knowledge that the health care
5.24directive has been revoked; and
5.25 (2) the health care provider believes in good faith that the health care agent is acting in
5.26good faith.
5.27 (c) A health care provider who administers health care necessary to keep the principal
5.28alive, despite a health care decision of the health care agent or default surrogate for health
5.29decisions to withhold or withdraw that treatment, is not subject to criminal prosecution,
5.30civil liability, or professional disciplinary action if that health care provider promptly took
5.31all reasonable steps to:
5.32 (1) notify the health care agent or default surrogate for health decisions of the health
5.33care provider's unwillingness to comply;
5Sec. 9.
25-03817 as introduced03/10/25 REVISOR SGS/LJ 6.1 (2) document the notification in the principal's medical record; and
6.2 (3) permit the health care agent or default surrogate for health decisions to arrange to
6.3transfer care of the principal to another health care provider willing to comply with the
6.4decision of the health care agent or default surrogate for health decisions.
6.5 (d) A health care provider is not subject to criminal prosecution, civil liability, or
6.6professional disciplinary action if the health care provider relies on a health care decision
6.7made by a default surrogate for health decisions when the following requirements are
6.8satisfied:
6.9 (1) the health care provider believes in good faith that the default surrogate for health
6.10decisions meets the requirements in section 145C.18, subdivision 1, clause (3); and
6.11 (2) the health care provider believes in good faith that the default surrogate for health
6.12decisions is acting in good faith.
6.13 Sec. 10. [145C.18] HEALTH CARE DECISIONS FOR UNREPRESENTED
6.14INDIVIDUALS.
6.15 Subdivision 1.Requirements to appoint.When a physician, advanced practice registered
6.16nurse, or physician assistant needs to obtain a health care decision from or on behalf of an
6.17individual, the physician, advanced practice registered nurse, or physician assistant may
6.18obtain the health care decision from a default surrogate for health decisions subject to the
6.19reasonable satisfaction, in the good faith and reasonable professional judgment of the
6.20physician, advanced practice registered nurse, or physician assistant of all the following
6.21conditions:
6.22 (1) the individual is an unrepresented individual pursuant to section 145C.01, subdivision
6.2310;
6.24 (2) the unrepresented individual does not have decision-making capacity pursuant to
6.25section 145C.01, subdivision 4, with respect to the health care decision and does not have
6.26the capacity pursuant to section 145C.02 to execute a health care directive, or has the capacity
6.27pursuant to section 145C.02 to execute a health care directive but declines to do so;
6.28 (3) each default surrogate for health decisions recognized by the physician, advanced
6.29practice registered nurse, or physician assistant:
6.30 (i) has demonstrated or expressed the willingness and ability to demonstrate good faith
6.31concern for the unrepresented individual;
6Sec. 10.
25-03817 as introduced03/10/25 REVISOR SGS/LJ 7.1 (ii) is familiar with or is willing and able to become familiar with and supportive of the
7.2unrepresented individual's current personal values and life choices;
7.3 (iii) would be reasonably available to make health care decisions;
7.4 (iv) would act in good faith;
7.5 (v) would be reasonably acceptable to the unrepresented individual given the
7.6unrepresented individual's reasonably determinable personal values and life choices; and
7.7 (vi) would not be considered ineligible to serve as a health care agent consistent with
7.8section 145C.03, subdivision 2; and
7.9 (4) the physician, advanced practice nurse, or physician assistant documents the process
7.10undertaken to satisfy the foregoing conditions and the rationale for the recognition of each
7.11default surrogate for health decisions.
7.12 Subd. 2.Other laws.Each default surrogate for health decisions recognized pursuant
7.13to subdivision 1 shall be considered to have specific authorization in law, including but not
7.14limited to section 144.293, subdivision 2, clause (2), and Code of Federal Regulations, title
7.1545, sections 164.502 and 164.510, paragraph (b), with respect to access to patient records
7.16relevant to the health care decision for which the default surrogate for health decisions is
7.17recognized.
7Sec. 10.
25-03817 as introduced03/10/25 REVISOR SGS/LJ