Colorado Advance Medical Directives - Medical Durable Power of Attorney - Advantages and Disadvantages to having a Living Will - Proxy Decision-Maker For Medical Treatment

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Colorado Advanced Directive Program - Advance Medical Directives. Every adult in the United States has the legal right to consent to or refuse medical treatment, under the Patient Self-Determination Act



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Colorado Advanced Directive Program


Advance Medical Directives

Every adult in the United States has the legal right to consent to or refuse medical treatment, under the Patient Self-Determination Act of 1990. All medical facilities receiving Medicare or Medicaid benefits must tell their patients about this law. Making your wishes known about the treatment you would want when you're incapacitated can be very helpful to doctors and to your family. You can do that on forms called "advance medical directives." They are requested when you check into a hospital - but you are not required to have them to receive care, treatment or admission.
If you become unable to make decisions concerning your medical treatment, another person, called an "agent," may make such decisions for you. This person should know your desires concerning medical treatment, so they can act on your behalf. If no arrangements are made for medical directives and you become incapacitated, the court may appoint a guardian for you. Signing advanced medical directives doesn't take away your right to decide on treatment, if you are able to do so.
Be sure to discuss your wishes and beliefs concerning medical treatment with your doctor, family and agent. Make copies of your advance directives for your doctor's files, agent, family and, if applicable, your health care facility. Discuss the policies of your health care provider and be sure they are compatible with your own beliefs and that your wishes will be honored.
Even though you don't need special forms, you can get ones for a Living Will and a Medical Durable Power of Attorney through Bradford Publishing Company and office supply stores. Be sure they are Colorado forms. A CPR Directive is available through your doctor's office or the Colorado Department of Health. These forms need to be signed by you (the patient), and some must also be signed by two witnesses. A CPR Directive must be signed by your doctor. It's useful sometimes to have the forms notarized.

Medical Durable Power of Attorney

A Medical Durable Power of Attorney perhaps is the most useful and practical of these directives. It is a legal document in which you name someone else (called an "agent" or an "attorney in fact") to make health care decisions for you if you can't make them, even if you are not terminally ill. Your agent can get copies of your medical records and other information in order to make medical decisions for you. You may appoint anyone to be your health care agent so long as that person is at least 18 years old, mentally competent and willing to serve as your agent. Your agent doesn't need to live in Colorado, but it usually makes things more convenient. You should also name a second person to serve in case the first person can't.
It's important to talk with your agent, your doctor and your family about what you would want, in the event you are incapacitated, about your medical care choices and your Medical Durable Power of Attorney. It is also important to talk with your doctor and your family regarding your wishes.
Your Medical Durable Power of Attorney may contain instructions to your agent about specific medical treatments, such as decisions about surgery, diagnostic tests or procedures. It may include a specific course of treatment for a known disease or condition, or a decision regarding nursing home care or other out-of-home placement. You can name an agent without giving specific instructions to that person.
If you decide to sign a Medical Durable Power of Attorney, you may want to attach a copy of another document called A Values History Form, which gives you an opportunity to discuss your values, wishes and preferences, as well as your overall attitude toward life and illness. This document can be very helpful to your agent in making specific decisions about your care.

Cardiopulmonary Resuscitation (CPR)

CPR is an attempt to revive someone whose heart and/or breathing has stopped. This attempt can be made by using special drugs or machines or pressing very firmly on the chest.
In Colorado, it is presumed you would want CPR unless you and your doctor have signed a form that allows you (or your agent or proxy) to refuse CPR.
If you have a CPR directive, and your heart and/or lungs stop, medical personnel won't try to press on your chest, or use breathing tubes, electric shock or anything else to get your heart and/or lungs working again. A CPR bracelet or necklace may be worn, indicating you don't want these emergency measures.
Signing a CPR directive won't prevent you from receiving other kinds of needed medical care such as treatment for pain, bleeding, broken bones or other comfort care.
If you are a patient in a health care facility and you don't have a CPR directive or aren't able to sign one, your doctor may decide, usually in consultation with you and/or family members, that resuscitation would be inappropriate. The doctor will write Do Not Resuscitate (DNR) or NO COR on your chart.

Living Wills

A Living Will has three purposes: It gives your doctor your instructions about life sustaining procedures, artificial nourishment and organ donation. If your doctor cannot, or will not, carry out your wishes, he or she must transfer you to a doctor who will do as you direct.
The Living Will document, which you sign, instructs your doctor to withhold or withdraw life-sustaining procedures in the event that at some future time, you are:
(1) terminally ill, or
(2) have been unconscious, comatose or otherwise incompetent for a specific period of time of no less than 48 hours, or
(3) unable to make or communicate responsible decisions about your care.
"Life sustaining procedures" means any medical procedure or intervention that would only to prolong the dying process. "Terminally ill" means an incurable or irreversible condition with no possibility of recovery, as agreed upon by two doctors in writing.
A Living Will can also direct your doctor to withhold or withdraw artificial nourishment if it is the only procedure being provided. If a doctor determines this will cause you pain, he/she will give you enough nourishment to alleviate pain. Through a Living Will, you can direct that artificial nourishment
1) be discontinued immediately,
2) be given to you for the time period you specify in the document, or
3) not ever be withheld. You must clearly choose only one of the three choices and initial that choice on the document.
A Living Will can also contain a written statement indicating your decision about organ and tissue donation.
Any competent person 18 years of age or older may execute a Living Will. If you are physically unable to sign the document, you can direct someone else to sign it for you. Such person cannot be
1) your doctor,
2) his employee or an employee of a health care facility where you are staying,
3) any person to whom you owe money,
4) or any person who believes he is entitled to your estate on your death. It is best to sign your own Living Will.
A Living Will must be witnessed by two people. None of the people listed above can witness it.
A Living Will can be destroyed any time you change your mind. You can do this by telling someone, revoking it in writing, or by destroying the document. Let your doctor, family and anyone who has a copy of it know that you've destroyed it.

Advantages to having a Living Will:

1. Difficult decisions about future care are made while you are competent, alert and not sick.
2. Your directions allow you to die under circumstances you have chosen. It makes your wishes clear in the event of a dispute as to what you might have wanted.
3. A Living Will removes the burden of decisions having to be made by grieving loved ones when you are dying.
4. A Living Will can reduce medical expenses.
5. A Living Will states your desires regarding organ donation at your death.

Disadvantages to having a Living Will:

1. A Living Will is effective in a very narrow set of circumstances.
2. The decisions you made may be hard for your family and create disharmony.
3. A parent, adult child, spouse or agent under a power of attorney can challenge the validity of the Living Will in court.
4. Acceptance out-of-state may be a problem.

Proxy Decision-Maker For Medical Treatment

When an adult doesn't have advanced medical directives and hasn't made his/her wishes known, under Colorado law someone can be chosen to make such decisions. That person would be chosen from among a group of "interested persons" including the person's spouse, parents, any adult child, sibling, grandchild, or any close friend of the patient. The intent of the law is to avoid guardianship proceedings.
The patient's attending physician must first determine that the adult patient lacks the ability to provide informed consent to or refusal of medical treatment. An effort must be made to tell the patient that he or she lacks the ability to provide informed consent, and that a close relative or friend will be selected to make medical decisions. The physician, or designee, must try to locate and notify as many of the "interested persons" as practical about the patient's lack of decisional capacity, and of the need to select a decision-maker for the patient.
The group of interested persons must try to reach a consensus among themselves as to which person among them should make medical decisions on behalf of the patient. Ideally, the person selected should have a close relationship with the patient and be likely to know the patient's wishes about medical treatment. The physician then tells the patient that a proxy has been selected, says who the person selected is, and explains the patient's right to object to the person selected.
If the group cannot agree on a decision-maker, or if the patient objects to the person selected, a guardianship proceeding must be instituted so that someone can make needed medical decisions on behalf of the patient.
The proxy decision-maker for medical care may authorize all decisions except removal or withdrawal of artificial nourishment and hydration. Such a decision by a proxy may be made only when the attending physician and a second independent physician trained in neurology or neurosurgery certify in the patient's chart that providing or continuing artificial nourishment or hydration is merely prolonging the act of dying, and it is unlikely to restore the patient to independent neurological functioning.
A proxy may ask for assistance from a medical ethics committee of the medical facility or ask the facility for an outside referral to provide assistance or consultation in making a medical decision.


This pamphlet is published as a public service by the Colorado Bar Association. Its purpose is to inform citizens of their legal rights and obligations and to provide information regarding the legal profession and how it may best serve the community. Changes may have occurred in the law since the time of publication. Before relying on this information, consult an attorney about your individual case.

"Colorado Advanced Directive Program"

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