Default Health-Care Surrogate Priority in Missouri
At a glance
| When the default route opens | No general adult family-proxy trigger in the checked consent scheme: § 431.061 names self-consent and a guardian for a ward; § 431.064(1) applies when an adult at a qualifying teaching hospital cannot consent to experimental treatment, a test, or a drug. |
|---|---|
| Care or setting covered | Family order in § 431.064(1) is confined to experimental treatment, tests, or drugs at a teaching hospital for an accredited medical school; § 431.061 covers ordinary medical/surgical consent without an adult family ladder. |
| Guardian or appointed agent | Guardian may consent for a ward under §§ 431.061(1)(6), 475.120(3); narrow § 431.064(1) names guardian and attorney-in-fact before family. |
| Family and partner order | Only for § 431.064's teaching-hospital experimental care: spouse, adult child, parent, brother or sister, then relative by blood or marriage. |
| Friend or other nonfamily person | The § 431.064(1) experimental-care list names guardian, attorney-in-fact, and relatives; it supplies no friend class. |
| Decision within one class | Section 431.064(1) ranks relationships but states no same-rank majority or unanimity method; the general § 431.061(3) one-consenter rule applies to people authorized by that section. |
| Who is available and eligible | For the narrow experimental route, spouse yields if absent, separated, incapable, whereabouts unknown, or overseas (§ 431.064(1)(1)); emergency implied consent has separate conditions (§ 431.063). |
| Decisions limited or excluded | Experimental-care surrogate may not override the incapable person's expressed permission (§ 431.064(2)); § 431.063 implies consent only within its medical-emergency conditions. |
| No surrogate or disputed authority | For life-threatening procedures with no time for guardian consent, § 475.123(2) allows a documented emergency procedure; court may authorize consent on petition under § 475.123(3)–(4). |
Requirements one by one
When the default route opens
Missouri § 431.061(1) authorizes an adult's own consent and a guardian's consent for a ward, along with routes for minors. It does not place an incapable adult's spouse or children in a general substitute-consent ladder. The family order in § 431.064(1) applies only to an incapable adult receiving experimental treatment, a test, or a drug at a teaching hospital for an accredited medical school.
Care or setting covered
Section 431.064(1) identifies the teaching-hospital setting and experimental care precisely. Section 431.061(1) is the broader medical and surgical consent provision. Treating the experimental-care list as a statewide answer for ordinary care would extend it beyond its words.
Guardian, family, and nonfamily order
Under § 431.061(1)(6) and § 475.120(3), a guardian may consent for a ward. The special § 431.064(1) route names a legal guardian or attorney-in-fact, then spouse, adult child, parent, brother or sister, and relative by blood or marriage. It has no friend class.
Decision within one class
Section 431.064(1) gives the relationship order for the experimental-care route. Section 431.061(3) says one person authorized by that general section can consent even if another such person objects. The provisions govern different consent settings.
Who is available and eligible
For § 431.064(1)(1), a spouse gives way if absent, separated, unable to consent, unlocatable, or overseas. The quoted section gives no comparable search or qualification formula for its later family classes.
Decisions limited or excluded
Section 431.064(2) forbids consent that contradicts the incapable person's expressed permission about that treatment. Separately, § 431.063 implies emergency consent only if its stated emergency, availability, and prior-protest conditions hold.
No surrogate or disputed authority
Section 475.123(2) permits an emergency procedure for a ward whose life is threatened when there is no time for guardian consent and medical necessity is documented. Subsection (3) lets a court authorize consent for a person whose life is threatened when consent cannot be obtained; subsection (4) adjusts the emergency hearing procedure.
What trips people up
The § 431.064 family sequence is real, but its opening sentence confines it to experimental care at a qualifying teaching hospital. The general consent list in § 431.061(1) is a different provision. Its single-consenter clause does not supply a vote for the separate experimental family classes.
Common questions
Can an adult child consent to ordinary care solely because of family rank? Section 431.061(1) does not list that route. Section 431.064(1) names an adult child only for its defined experimental-care setting.
Can treatment proceed in an emergency without a relative's signature? Section 431.063 provides implied consent when its medical-emergency conditions are met.
Can a court authorize a life-threatening procedure? Yes, under the petition and hearing terms of § 475.123(3)–(4).
Statutes and sources
- Mo. Rev. Stat. §§ 431.061, 431.063–.064, 475.120, 475.123. Verbatim official text excerpts, source links, and access dates appear in the source fields above.
Source links
Every statute quoted above, linked, with the date we checked it.
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