Advance Directives in Colorado
Please be aware that what follows is just information, not advice. Every situation is different. For questions about your particular situation, please consult the appropriate qualified professional: healthcare practitioner, attorney, or estate planner. While the help of a lawyer is not required for any of these documents, low-cost legal assistance is available. Consult the Colorado Bar Association website (click on “For the Public” and “Legal Assistance Programs”).
More information about Colorado's advance directive documents as well as blank copies of the documents are available in the booklet "Your Right to Make Health Care Decisions," which is available here in English and Spanish.
MEDICAL DURABLE POWER OF ATTORNEY
- In Colorado, no one is automatically authorized to make healthcare decisions for another adult.
- The Medical Durable Power of Attorney (also called the “Power of Attorney for Healthcare”) is a document you sign to appoint someone to make your healthcare decisions for you. The person you name is called your healthcare agent.
- In most cases, your agent only makes decisions for you when you cannot. This may be temporary, while you recover from an accident or injury, or long term, if you are permanently incapacitated.
- Your agent can get copies of your medical records, consult with your doctors and other healthcare providers, and make all decisions necessary for your care.
- Your agent is supposed to act according to your wishes and values, so it’s important to talk to them about your life values, your goals, and your preferences for treatment. Ideally, the agent is someone who knows you very well. He or she must be able to devote the time and energy to handling your health care needs.
- Click here for more information on how to select a healthcare agent, and how to serve as a healthcare agent.
- A Medical Durable Power of Attorney (MDPOA) is not the same as a general Power of Attorney (POA). The MDPOA agent is only authorized to make healthcare decisions. A general POA covers legal and financial affairs. The authority of both types of agent ends at your death.
LIVING WILL
- In Colorado, the Living Will is called the “Declaration as to Medical or Surgical Treatment.”
- It tells your doctor what to do about artificial life support measures if you have a terminal illness and unable to speak for yourself, or you are in a "persistent vegetative state" (a state of permanent unconsciousness involving massive brain damage but not "brain death.")
- In Colorado, your Living Will does not go into effect until 48 hours after two doctors agree in writing that you have a terminal condition and are unable to speak for yourself or you are in a persistent vegetative state.
- In these circumstances, your Living Will directs your doctors to continue or discontinue, as you specified in the document, life-sustaining procedures, artificial nutrition, and artificial hydration.
- In the Living Will document, you can list people you want to be kept informed of your condition and the doctors' certification of terminal illness or persistent vegetative state.
- You may also detail other medical instructions, but these instructions will only be followed when your living will goes into effect (that is, after the doctors' certification).
- You do not need an attorney or a doctor to complete a Living Will, but you do need two witnesses. The witnesses cannot be your healthcare providers, an employee of your healthcare provider, your creditors, or anyone likely to inherit property from you.
- A notary’s signature and seal is a good idea but not required.
- A Living Will is not the same as a regular will (“Last Will and Testament”) or a Living Trust, which refer to possessions and property. A Living Will only provides instructions on medical treatment, not the distribution or disposal of your property.
CPR DIRECTIVE
- A CPR (cardiopulmonary resuscitation) directive allows you to refuse in advance any attempt to resuscitate you by chest compressions, medications, defibrillation (electric shock), or intubation (artificial breathing machine) if your heart or breathing malfunctions or stops.
- CPR directives are almost always used by people who are severely or terminally ill or elderly. For them, the trauma involved in CPR is likely to do more harm than good, but emergency personnel are required to perform CPR unless a directive tells them not to.
- A CPR directive is not the same as a DNR order. A DNR order is a doctor’s order made for severely ill patients in healthcare facilities, including nursing homes. The DNR does not require the patient’s consent, and it expires when the patient leaves the facility.
- The Colorado CPR directive must be signed by both the individual (or the individual’s MDPOA agent or “proxy”—see below) and his/her physician. Other CPR directive forms may not require a physician’s signature.
- A CPR directive form does NOT have to be “original” nor do the signatures have to be “original.” Photocopies, scans, and faxes are just as valid as the original.
- CPR directives must be immediately visible to emergency personnel. For more active folks with CPR directives, a wallet card or special CPR directive bracelet or necklace can be obtained.
MEDICAL PROXY FOR DECISION MAKING
- In Colorado, no one is given automatic authority to make decisions for another adult, and healthcare providers cannot simply make decisions for patients except in an emergency.
- If you have not appointed a healthcare agent, and if you are unable to make or express decisions for yourself, a “proxy” is needed.
- The physician has the responsibilty to gather together all the people who have an interest in your well-being, for instance your spouse or partner, parents, adult children, grandchildren, brothers or sisters, close friends, or even professional advisors such as clergy, attorneys or financial managers.
- The group of "interested parties" must agree by consensus which one of them will serve as your "proxy" decision maker.
- Like your agent, your proxy should act according to your wishes and values, so the proxy should be the one who knows your medical treatment wishes the best.
- Proxies selected in this way cannot refuse artificial nutrition and hydration for you, unless two doctors agree that such treatment would not help you get well but would only prolong dying.
- If the group can’t agree on who the proxy should be, then guardianship needs to be pursued through the courts.
A Word About Advance Care Planning for Children and Teens with Serious Illness
Persons under the age of 18 cannot legally sign advance directive documents; their parents or legal guardians are responsible for their medical decisions.
When a baby, child, or teen faces serious illness, parents can meet with healthcare professionals and develop an advance care plan. Older children and especially teens can have a voice in putting together the advance care plan.
The plan outlines in writing the parents’/child’s preferences for care in case of an emergency situation or in cases where all treatment options have been explored.
If you are caring for a seriously ill child, here’s what to do:
- Request a family conference with your physician and primary nurse. You may also want to include a social worker, spiritual advisor, or close family friend.
- Discuss with your doctor/nurse their plan of care for your child, including palliative care for pain, uncomfortable symptoms, and emotional-psychological-spiritual support.
- Discuss whether a Colorado CPR Directive might be appropriate for your child in case of an emergency.
- If appropriate, talk over choices and likely results with your child and include him or her in your decisions. As parents, you have the final say, but even young children can benefit from being included in the decision making.
