Statutes Governing Default Surrogate Decision Making for Mental Health Treatment

Area of Science:

• Legal and ethical aspects of mental healthcare.
• Public health policy and disparities.

Background:

• Incapacitated patients often rely on default surrogates for mental health treatment decisions.
• Existing state statutes present a complex landscape for surrogate authority.

Purpose of the Study:

• To analyze and describe variations in state statutory authority for default surrogates in mental health decision-making.
• To identify differences in the scope of powers granted to surrogates across U.S. states.

Main Methods:

• Comprehensive review of state statutes governing default surrogate decision-making for mental health treatment.
• Analysis of laws from all 50 U.S. states and the District of Columbia.
• Independent review by three researchers with data updated in January 2020.

Main Results:

• Significant heterogeneity exists in state laws regarding surrogate authority for mental health treatment.
• Eight states grant broad decision-making powers to default surrogates.
• Twenty-five states explicitly prohibit surrogates from consenting to specific therapies, while thirteen remain silent.

Conclusions:

• Variability in state laws complicates mental healthcare for incapacitated patients.
• This legal complexity hinders support for surrogates and clinicians.
• Disparities in healthcare may arise due to inconsistent statutory frameworks.