Default Health-Care Surrogate Priority in Rhode Island
At a glance
| When the default route opens | No general default family trigger in the checked health and guardianship provisions; MOLST decision maker must already be authorized by law or patient (§§ 23-4.11-2(7), 23-4.11-3.1(b)(2)). |
|---|---|
| Care or setting covered | General care consent belongs to the patient or appointed agent; terminal-care MOLST provision covers qualified patient and life-sustaining orders (§§ 23-4.6-1(a), 23-4.10-2, 23-4.11-2(16), 23-4.11-3.1). |
| Guardian or appointed agent | Patient-appointed health-care agent has document-granted authority; court-appointed guardian acts within order and best-interest duty (§§ 23-4.10-2, 33-15-8, 33-15-29). |
| Family and partner order | No spouse, child, parent or sibling ranking supplied by the checked health-care and guardianship provisions (§§ 23-4.10-2, 23-4.11-2(7), 33-15-8). |
| Friend or other nonfamily person | No default close-friend class in the checked provisions; an individual may designate an agent (§§ 23-4.10-2, 23-4.11-2(7)). |
| Decision within one class | No same-rank vote is prescribed by the checked provisions because they do not create ranked family classes (§§ 23-4.10-2, 23-4.11-2(7)). |
| Who is available and eligible | MOLST decision maker must have authority from law or patient; limited guardian has only order-granted authority (§§ 23-4.11-2(7), 33-15-8). |
| Decisions limited or excluded | MOLST authority concerns qualified terminal patients; a recognized maker may sign when capacity is lacking; guardian acts for ward’s best interest (§§ 23-4.11-2(16), 23-4.11-3.1(b)(2), (d)(2), 33-15-29). |
| No surrogate or disputed authority | Checked statutes supply no family tie-break or clinician appointment rule; guardian authority depends on court order (§§ 23-4.11-2(7), 33-15-8). |
Requirements one by one
What the statutes provide
Section 23-4.6-1(a) recognizes an individual's consent to routine, emergency, medical or surgical care. A person who has designated a health-care agent gives that agent decision authority through the statutory power-of-attorney form (§ 23-4.10-2). The adult guardianship chapter says a limited guardian has only the authority stated in the order, (§ 33-15-8), and a guardian authorized to decide for the person must act in the ward's best interest (§ 33-15-29).
The terminal-care chapter defines a “healthcare decision maker” as someone authorized by law or by the qualified patient (§ 23-4.11-2(7)). Such a maker may execute a MOLST form when the qualified patient lacks capacity, with the required clinician signature (§ 23-4.11-3.1(b)(2), (d)(2)). This definition points to authority already established elsewhere; it does not rank relatives.
What trips people up
The MOLST rule names a “recognized healthcare decision maker” but does not itself give every spouse or adult child authority. Before treating a relative's signature as sufficient, the underlying source of that person's authority must be identified (§§ 23-4.11-2(7), 23-4.11-3.1(d)(2)).
Common questions
Does a spouse automatically outrank adult children under these provisions?
The cited health-care and guardianship provisions do not prescribe that family order. The statutory agent route depends on designation, while a limited guardian's authority comes from the court order (§§ 23-4.10-2, 33-15-8).
Can a MOLST form create a new default family surrogate?
No priority class is created by the MOLST signing rule. It calls for the qualified patient or a recognized decision maker and a qualified provider to sign (§§ 23-4.11-2(7), 23-4.11-3.1(d)(2)).
Statutes and sources
- R.I. Gen. Laws §§ 23-4.6-1, 23-4.10-2, 23-4.11-2, 23-4.11-3.1, 33-15-8 and 33-15-29 — current official provisions linked in the statute entries above, accessed 2026-10-08.
- Official Title 23 index and Title 33 index, plus the indexed chapters on health-care powers of attorney, terminal-care declarations and adult guardianship, checked 2026-10-08 to bound the absence finding.
Source links
Every statute quoted above, linked, with the date we checked it.
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