How Does an Advance Directive Work in Medical Situations?
May 29, 2025
An advance directive is a legal document that allows individuals to outline their preferences for medical treatment in the event they become incapacitated and cannot communicate their wishes.
Advance directives play a critical role in confirming that a person’s healthcare decisions are respected, particularly in situations involving serious illness, end-of-life care, or incapacitation.
Understanding how advance directives function in medical situations in Missouri, including their legal structure, types, creation process, implementation, and practical considerations.
Knowing this, individuals can better prepare for future medical scenarios and confirm their values and preferences guide their care. For more information, contact David W. Walker, Attorney at Law, in Columbia, Missouri.
What Is an Advance Directive?
An advance directive is a written statement of a person’s wishes regarding medical treatment, designed to take effect when they are no longer able to make decisions due to illness or incapacity.
In Missouri, advance directives are governed by state law, primarily the Missouri Durable Power of Attorney for Health Care Act and the Missouri Living Will statute. These laws confirm that healthcare providers and family members adhere to the individual’s documented preferences.
Advance directives typically include two main components:
Living Will: A document that specifies the types of medical treatments a person wants or does not want if they are terminally ill or permanently unconscious.
Durable Power of Attorney for Health Care (Health Care Proxy): A designation of a trusted individual, known as a healthcare agent or proxy, who is authorized to make medical decisions on behalf of the person if they are incapacitated.
In Missouri, these components, a living will and designation of a power of attorney, can be combined into a single document or created separately, depending on the individual’s preferences.
Medical Laws in Missouri
Missouri’s laws for advance directives are outlined in Chapter 404 and Chapter 459 of the Missouri Revised Statutes. These statutes establish the requirements for creating valid advance directives and define how they are implemented in medical situations. Key legal principles include:
Capacity: To create an advance directive, an individual must be at least 18 years old and of sound mind, meaning they have the mental capacity to understand the document’s purpose and implications.
Voluntariness: The directive must be created voluntarily, without coercion or undue influence.
Formalities: Missouri law requires advance directives to be written, signed by the individual (or their designee if they are physically unable to sign), and witnessed by two individuals who are not related to the person or entitled to any portion of their estate.
Revocability: An advance directive can be revoked at any time by the individual, regardless of their mental or physical condition, through a written or oral statement or by destroying the document.
Missouri law also recognizes advance directives executed in other states, provided they comply with the laws of the state where they were created or with Missouri’s requirements.
Types of Advance Directives in Missouri
Living Will
A living will in Missouri is a written declaration that outlines a person’s preferences for medical treatment in specific situations, typically when they are terminally ill or permanently unconscious.
According to Missouri Revised Statutes Section 459.015, a terminal condition is defined as an incurable or irreversible condition that, in the opinion of the attending physician, will result in death within a relatively short time without the administration of life-sustaining treatment.
A living will may address treatments such as:
Artificial nutrition and hydration (tube feeding).
Mechanical ventilation (breathing machines).
Cardiopulmonary resuscitation (CPR).
Dialysis.
Palliative care or pain management.
For example, an individual might specify that they do not want artificial nutrition and hydration if they are in a persistent vegetative state but wish to receive pain relief to confirm comfort.
Durable Power of Attorney for Health Care
The durable power of attorney for health care allows an individual to appoint a healthcare agent to make medical decisions on their behalf if they become incapacitated. This agent has the authority to consent to, refuse, or withdraw treatment, guided by the individual’s expressed wishes or best interests.
In Missouri, the healthcare agent’s authority is broad but must align with the individual’s known preferences, as outlined in the advance directive or communicated verbally. The agent can make decisions in situations not covered by a living will, such as temporary incapacity or non-terminal conditions requiring medical intervention.
Creating an Advance Directive in Missouri
Creating an advance directive in Missouri involves several steps to make sure the document is legally valid and reflects the individual’s wishes. The process includes:
Reflection and Discussion:
Individuals should reflect on their values, beliefs, and medical preferences. Questions to consider include: What quality of life is acceptable? What treatments are desired or unwanted in specific scenarios?
Discuss these preferences with family members, healthcare providers, and the designated healthcare agent to verify clarity and alignment.
Drafting the Document:
Missouri does not require a specific form, but standardized forms are available from hospitals, legal aid organizations, or the Missouri Bar Association.
The document should clearly state the individual’s medical preferences and designate a healthcare agent, including contact information and any alternate agents.
Specific instructions, such as “Do Not Resuscitate” (DNR) preferences or desires for hospice care, should be explicitly included.
Signing and Witnessing:
The individual must sign the document in the presence of two witnesses, who must also sign to attest to the individual’s capacity and voluntariness.
Witnesses cannot be the healthcare agent, related to the individual, or beneficiaries of the individual’s estate.
Notarization is not required in Missouri but can add an extra layer of authenticity.
Distribution and Storage:
Copies of the advance directive should be provided to the healthcare agent, primary care physician, and any relevant healthcare facilities.
The original document should be stored in an easily accessible location, such as with important legal papers, but not in a safe deposit box, as it may be inaccessible when needed.
Individuals may also register their advance directive with the Missouri Health Care Directive Registry, a voluntary service that allows healthcare providers to access the document electronically.
Creating an advance directive in Missouri requires careful reflection, clear documentation, proper witnessing, and strategic distribution to confirm an individual’s healthcare preferences are honored. For assistance, contact David W. Walker, Attorney at Law, in Columbia, Missouri.
Implementation in Medical Situations
Advance directives come into effect when an individual is deemed incapacitated, meaning they cannot communicate or make informed decisions about their medical care. In Missouri, the attending physician or healthcare provider determines incapacity, often in consultation with other medical professionals.
Role of the Healthcare Agent
Once incapacity is established, the healthcare agent assumes decision-making authority. The agent’s responsibilities include:
Interpreting the individual’s advance directive and applying it to the current medical situation.
Making decisions in the individual’s best interests if the directive does not address the specific scenario.
Communicating with healthcare providers to confirm the individual’s wishes are followed.
For example, if a person with a living will specifying no mechanical ventilation is admitted to the hospital in a coma, the healthcare agent would advocate for withholding ventilator support, provided the condition aligns with the directive’s criteria (e.g., terminal illness or permanent unconsciousness).
Role of Healthcare Providers
Missouri healthcare providers are legally obligated to honor valid advance directives to the extent permitted by law and medical standards. Providers must:
Review the advance directive to confirm its validity and applicability.
Consult with the healthcare agent or follow the living will’s instructions.
Document the directive in the patient’s medical record.
If a provider has ethical or professional objections to following the directive (e.g., a refusal to withdraw life-sustaining treatment), they must transfer the patient’s care to another provider or facility willing to comply.
Limitations and Challenges
While advance directives are powerful tools, their implementation can face challenges:
Ambiguity: Vague or overly general instructions may lead to misinterpretation. For example, a directive stating “no extraordinary measures” may be unclear without defining what constitutes “extraordinary.”
Lack of awareness: If healthcare providers or family members are unaware of the directive, it may not be followed. This underscores the importance of distributing copies and discussing the document in advance.
Family disagreements: Family members may disagree with the directive or the healthcare agent’s decisions, potentially leading to conflicts or legal challenges.
Emergency situations: In emergencies, medical teams may initiate life-sustaining treatment if the directive is not immediately available or known.
To mitigate these challenges, individuals should confirm their directive is specific, widely distributed, and regularly updated to reflect changing preferences or circumstances.
Contact a Probate Lawyer Today
In Missouri, advance directives are essential tools for confirming that an individual’s medical preferences are respected in situations where they cannot speak for themselves. By combining a living will and a durable power of attorney for health care, individuals can address specific treatment preferences and designate a trusted agent to make decisions on their behalf. For assistance, contact David W. Walker, Attorney at Law, in Columbia, Missouri. I also serve Jefferson City, Fulton, and Boonville.