Advance Directives

An advance directive is a means of exercising control of an individual’s personal affairs in anticipation of a time when he or she may not be able to communicate them to others. Pre-planning provides individuals with an opportunity to record personal wishes for and can help to alleviate family and loved ones’ concerns over what care is appropriate. Adopting one or more advance directives can help to preserve a person’s autonomy, as well as possibly eliminating the need for legal intervention should the person become physically or mentally incapacitated.

These directives cover a variety of situations and can be adopted individually, together or only the specific ones that a person needs. They may cover financial and legal authority, medical decision-making, living wills and estate planning. This list is not exhaustive, but representative of the most common and useful directives.

Adopting advance directives is often a difficult decision for individuals who have not yet considered end-of-life planning. However, such decisions should be made at the same time as executions of wills and other end-of-life documents, to ensure that the individual has sufficiently set out guidelines for the time leading up to his/her passing and not only afterward.

The most common advance directives include:

CPR Directive (aka Do Not Resuscitate Order or DNR)
The CPR Directive instructs medical personnel to withold Cardiopulmonary Resuscitation (CPR) in the event a patient’s heart or breathing stops. By law this is an opt-out medical service, with the legal assumption being that an individual has consented to CPR unless a Directive is executed. A CPR Directive may be issued independently or as part of the MOST form discussed below. A CPR Directive must be signed by the primary physician and the individual (or the individual’s Medical Power of Attorney or Medical Health Care Proxy) in order to be valid. It is recommended to keep a copy at all times, as EMT or other emergency personnel may not be adequately informed of an individual’s intentions.
Medical Orders for Scope of Treatment (MOST)
The MOST is a form executed by both an individual and his/her physician, advanced practice nurse or physician assistant. It outlines the broad wishes for care, including the use of CPR, antibiotics, artificially administered nutrition and the level of medical intervention. It is intended for chronically or seriously ill patients who will interact with many health care professionals where a standardized form is helpful. The form follows an individual from one health care setting to another, and organizations are assumed to comply with MOST unless they specifically inform an individual and offer him/her transfer to a facility that does comply.
Medical Health Care Proxy
This is a document drawn up by interested parties to assign an individual the right to make medical decisions for another individual who is unable to make his/her own decisions and does not have a medical power of attorney. The health care proxy can eliminate the need to go to court for a full guardianship to medical decisions for the incapacitated individual. There is no standardized document, but many physicians and hospitals may have their own form. Because this is not standardized, the authority does not follow an individual and must be confirmed by the interested parties after every transfer.
Living Will (aka Declaration As To Medical or Surgical Treatment)
A living will provides for the termination of medical intervention after the attending physician and another physician have determined that the suffered condition is irreversible and the patient has been comatose for seven consecutive days. Forty-eight hours later, artificial nourishment or life-sustaining procedures can then be terminated. A living will is a legal document, but should be accompanied by a medical power of attorney to verify that an individual’s wishes will be faithfully executed.
Medical Durable Power Of Attorney (aka MPOA, MDPOA)
An instrument which authorizes a named agent to make any and all health care decisions for an individual upon incapacitation. While legally recognized, there is no standardized form and individuals are free to make their own or use another one. There can be limitations on what authority is given to the agent, what specific treatment should be pursued in specific cases, how it relates to other directives and anatomical gifts. An individual must give informed consent to a MPOA, meaning that the individual must be commonly judged to be of sound mind and capable of understanding the repercussions of such an action. Individuals who cannot give consent cannot have a MPOA, and must instead use a medical health care proxy or court-appointed guardianship.
General Durable Power Of Attorney (aka POA, GPOA, GDPOA, DPOA)
A general power of attorney gives the agent (or co-agents or successor agents) comprehensive authority over an individual’s legal and financial affairs, or specific grants of authority within those areas. This is primarily intended for individuals who are not capable of managing all or part of their affairs any longer. Like a medical power of attorney, the individual must give informed consent for a POA to be valid. All general powers of attorney executed after January 1, 2010 in Colorado must conform to the Uniform Power of Attorney Act. This specifies that a form must be substantially of the same text as written in statute, though with the ability to modify the form as appropriate for specific grants of authority and durations.
Designated Beneficiary Agreement