HB191 Alabama 2022 Session

Summary

Primary Sponsor

Ed OliverRepresentative

Republican

Session

Regular Session 2022

Title

Natural Death Act, certification of surrogate to make end of life health care decisions, notarization requirement removed, Sec. 22-8A-11 am'd.

Summary

HB191 creates a structured surrogate-based process for end-of-life decisions when there is no valid advance directive, with certification and liability protections for participants.

What This Bill Does

It allows a competent adult surrogate to decide to provide, withdraw, or withhold life-sustaining treatment or artificially provided nutrition and hydration for a terminally ill or permanently unconscious patient when no directive exists, following strict medical criteria. The surrogate must consult with the attending physician and act in line with what the patient would want, with clear rules for when the patient cannot express desires (especially if permanently unconscious). It establishes a priority order for who may serve as surrogate, requires ethics review in certain cases, and provides liability protections for providers and surrogates, along with penalties for false certification.

Who It Affects

• Terminally ill patients lacking an advance directive who may have a designated surrogate make end-of-life care decisions under the act.
• Potential surrogates and health care providers involved in end-of-life decisions, who gain authority to act under the act, must follow certification rules, and receive liability protections when acting in good faith.

Key Provisions

• Creates surrogate-based end-of-life decision-making when no advance directive exists, with specific medical criteria (two physicians certify terminal illness or permanent unconsciousness, and no known directive).
• Requires the surrogate to be a competent adult and to consult with the attending physician, aiming to reflect the patient’s wishes and beliefs; withdrawal of nutrition for a permanently unconscious patient requires clear and convincing evidence of the patient’s desires.
• Establishes a priority order for surrogate selection (guardian with court authorization; spouse; adult child; parents; adult siblings; other relatives; ethics committee if no relatives).
• Facilities must notify the Alabama Department of Human Resources if an ethics committee is involved in the surrogate decision process.
• Surrogate must certify under oath that they contacted appropriate relatives or classes and that consent or no objections were obtained; certification is included in the medical record.
• Defines validity conditions for surrogate decisions when some contacts are unavailable or unreachable, excluding those individuals from the consent determination in certain cases.
• Provides civil/criminal liability protections for health care providers and surrogates acting in good faith on surrogate decisions; liability only for false or fraudulent certifications.
• Board of Health must prescribe a notarized form with two witnesses (not related to the patient or provider) to certify the surrogate; form includes a perjury statement.
• Allows disputes to be resolved in circuit court via declaratory or injunctive relief; multiple claimants may seek relief.
• Cannons of penalties: Class C felony for knowingly false certification; penalties in addition to other offenses.
• Effective date: the act takes effect on the first day of the third month after passage and governor approval.

AI-generated summary using openai/gpt-5-nano on Feb 22, 2026. May contain errors — refer to the official bill text for accuracy.

Subjects

Health CareHealth