Examine the significance and limitations of the 'nominated representative' framework under the Mental Healthcare Act, 2017 in addressing healthcare decision-making rights of unmarried and same-sex partners.

Section 14 of the Mental Healthcare Act, 2017 allows a competent adult to appoint a nominated representative by a simple written declaration to decide for them during incapacity [1]. Because it turns on consent, not marital status, it has become the default route for unmarried and same-sex partners — but it carries the limits of a borrowed tool.

Significance

• Autonomy over status: the nominee is chosen by the patient, so a partner excluded from "next of kin" can still be empowered [1].
• Low procedural threshold: nomination requires only a plain written, signed declaration, not a notarised power of attorney [1].
• Anchor for administrative extension: the Union Health Ministry and the National Medical Commission told the Delhi High Court (September 2026) that nominating a same-sex partner is accommodable "within the existing legal and ethical framework" [4].
• Fills the post-Supriyo vacuum: the Supreme Court left marriage recognition to Parliament (2023) and dismissed review pleas in January 2025 [2][3], leaving such nomination the only available protection.

Limitations

• Narrow statutory domain: the Act governs mental-healthcare decisions; surgical consent or withdrawal of life support is not textually covered — the extension works by analogy [1].
• Pre-emergency paperwork: the power flows from a document, not the relationship; a spouse is presumed next of kin, a partner without a form is a stranger. The petitioner had cohabited in Delhi since 2018 yet had to move the High Court [4].
• Relative-first default: absent nomination, the Act's scheme falls back on relatives or caregivers [1].
• No enforceability: an affidavit is not an NMC regulation; a hospital refusing a partner at the consent desk attracts no penalty [4].
• Fragmented rights: inheritance, adoption and pension still follow "spouse" [4].

The framework is thus a genuine but fragile opening. Converting it into an NMC professional-conduct regulation, a standard national consent form carrying a nominee column, and a consolidated statement of entitlements would give the principle of dignity and autonomy under Article 21 practical effect at the hospital counter.