More Choosers, Fewer Choices? Supported and Medical Decision-Making Law Post-Dobbs

This Article focuses on two conflicting trends in the law of medical decision making. More states are adopting supported decision-making legislation, wherein an individual with a disability receives decision-making assistance from someone they elect to serve as a “supporter.” In the absence of supported decision making, adults with significant decisional impairments may be disqualified from making contemporaneous medical decisions. But with the advent of supported decision making, more patients with impaired cognition may have the legal authority to make contemporaneous medical decisions. While the number of people eligible to make decisions is potentially increasing due to widespread adoption of supported decision-making laws, states simultaneously are restricting access to some types of medical procedures including abortion, use of assisted reproductive technologies, and gender affirming medical care. This Article demonstrates that these two legal trends may result in more patients making medical decisions while having access to fewer medical procedures. That is, states are both facilitating and restricting patient autonomy. This Article discusses possible reasons for these conflicting trends and highlights directions for future research.