Statutes Governing Default Surrogate Decision Making for Mental Health Treatment

Psychiatr Serv. 2021 Jan 1;72(1):81-84. doi: 10.1176/ Epub 2020 Oct 14.


Objective: The authors sought to describe state-to-state variations in the scope of statutory authority granted to default surrogates who decide on mental health treatment for incapacitated patients.

Methods: The authors investigated state statutes delineating the powers of default surrogates to make decisions about mental health treatment. Statutes in all 50 U.S. states and the District of Columbia were identified and analyzed independently by three reviewers. Research was conducted from August 2017 to November 2018 and updated in January 2020.

Results: State statutes varied in approaches to default surrogate decision making for mental health treatment. Eight states' statutes delegate broad authority to surrogates, whereas 25 states prohibit surrogates from giving consent for specific therapies. Thirteen states are silent on whether surrogates may make decisions.

Conclusions: Heterogeneity among state statutory laws contributes to complexity of treating patients without decisional capacity. This variability encumbers efforts to support surrogates and clinicians and may contribute to health disparities.

Keywords: Advance directives/proxies; Law and psychiatry; Mental health care; State laws; Surrogate decision makers.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Decision Making*
  • District of Columbia
  • Humans
  • Mental Health*