Default Health-Care Surrogate Priority in Oregon
At a glance
| When the default route opens | Family route requires incapacity, no appointed representative or applicable directive, and a medically confirmed qualifying condition (§ 127.635(1)–(2)); hospital route requires inability to decide and failed searches (§ 127.760(3)). |
|---|---|
| Care or setting covered | Family order covers life-sustaining withdrawal; separate hospital route covers medically necessary inpatient care; service-team advocate route covers qualifying developmental-disability services (§§ 127.635, 127.760, 127.765). |
| Guardian or appointed agent | Available appointed health-care representative has priority; in the § 127.635 family route an authorized guardian ranks first (§§ 127.535(1), 127.635(2)(a)). |
| Family and partner order | Authorized guardian; spouse; adult unanimously designated by reachable listed people; majority of adult children; either parent; majority of adult siblings; adult relative or friend (§ 127.635(2)). |
| Friend or other nonfamily person | Adult friend is final family-route class; hospital may appoint ethics-trained provider after failed search; service team may appoint advocate for qualifying disability services (§§ 127.635(2)(g), 127.760(2)–(3), 127.765(2)–(3)). |
| Decision within one class | Majority of reachable adult children or siblings; designated adult needs no objection from reachable listed people; no vote specified for final relative/friend class (§ 127.635(2)(c)–(g)). |
| Who is available and eligible | Facility makes reasonable effort to locate a willing family-route representative; hospital route requires searches for representative, relative or friend, and instruction (§§ 127.635(2), 127.760(3)). |
| Decisions limited or excluded | Family route requires qualifying condition, consultation, and provider supervision; nutrition/hydration has statutory presumption and exceptions; hospital appointee cannot consent to listed sensitive care (§§ 127.580, 127.635, 127.760(5)). |
| No surrogate or disputed authority | If no § 127.635 person is available, attending clinician may supervise life-sustaining withdrawal; hospital may appoint ethics-trained provider for necessary care after searches (§§ 127.635(3), 127.760(2)–(3)). |
Requirements one by one
The family route for life-sustaining procedures
Under § 127.635(1), the family route concerns withholding or withdrawing life-sustaining procedures for an incapable person without an appointed representative or applicable directive. The qualifying condition must be medically confirmed: terminal condition, permanent unconsciousness, the specified severe-pain and no-benefit condition, or the advanced progressive illness described in subsection (1)(d). This is a decision-specific order.
Section 127.635(2) ranks an authorized guardian, spouse, an adult designated without objection by reachable listed people, a majority of reachable adult children, either parent, a majority of reachable adult siblings, and any adult relative or friend. The facility must use reasonable effort to locate a willing person. If nobody in those classes is available, subsection (3) permits withholding or withdrawal under the attending physician's or provider's direction and supervision.
Under § 127.635(4), the decision maker must consult concerned family and close friends and notify a case manager when applicable. The subsection also covers an election for hospice treatment. Subsection (5) adds a case-manager inquiry and notice for a person with an intellectual or developmental disability; subsection (6) excludes a parent or former guardian with the specified protective-custody or parental-rights history.
Separate care routes
Section 127.760(2)–(3) permits a hospital to appoint an ethics-trained provider for medically necessary care of an admitted patient who cannot make or communicate decisions. The hospital must first reasonably search for an appointed representative, capable adult relative or friend, and the patient's health-care instructions. A multidisciplinary or ethics committee may participate; when the attending physician is the appointee, another qualified provider must also participate. Section 127.760(5) bars that appointee from consenting to mental-health treatment, sterilization, abortion, and the specified life-sustaining or nutrition decisions except under the cross-referenced conditions.
For an adult with an intellectual or developmental disability receiving services through an individualized plan, § 127.765(2)–(3) allows the plan team to appoint a capable, willing health-care advocate with the required two-thirds approval. The advocate's separate limits and the patient's protest rights appear in § 127.765(5), (8), and (12). This service route is tied to that population and plan, rather than the general family order.
Wishes and nutrition
Section 127.535(1) gives an available health-care representative priority over others for decisions within authority while the principal is incapable. Subsections (4)–(5) require regard for the principal's known desires and prevent withholding or withdrawal of life-sustaining procedures or artificial nutrition and hydration over the principal's manifested objection.
Section 127.580(1) presumes consent to life-sustaining artificial nutrition and hydration, subject to its stated exceptions. When the presumption is overcome under the listed conditions and no appointed representative or applicable directive exists, subsection (2) directs withholding or withdrawal through § 127.635(2)–(4).
What trips people up
A spouse's place in § 127.635(2) is part of the life-sustaining withdrawal route after the medical condition finding. It is not a statewide order assigning ordinary medical decisions to every spouse.
The hospital appointee under § 127.760(7) is expressly not a “health care representative” as defined in § 127.505. The hospital route has its own searches and decision limits.
Common questions
Can a friend decide? Section 127.635(2)(g) puts an adult friend in the final life-sustaining class; the hospital may separately appoint a qualified provider after its § 127.760(3) searches fail.
Can relatives choose one adult to speak for them? Section 127.635(2)(c) permits an adult designated by reachable listed people if nobody among them objects.
Who acts if the family route finds no one? Section 127.635(3) permits the attending physician or provider to direct and supervise the specified life-sustaining decision.
Statutes and sources
Verbatim official excerpts, the chapter URL, and access dates are in the source fields above.
Source links
Every statute quoted above, linked, with the date we checked it.
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