Default Health-Care Surrogate Priority in Colorado

At a glance

Requirements one by one

When the proxy route opens

Section 15-18.5-103(1) applies when an adult patient cannot give informed consent or refusal and there is no guardian with medical authority, medical durable-power agent, designated-beneficiary proxy, or other known legally authorized person. Under subsection (2), a court, attending physician, or collaborating advanced practice registered nurse may determine incapacity and document it; the attending physician records specific findings about its cause, nature, and projected duration.

Who is considered

Section 15-18.5-103(1.5) calls a spouse, either parent, any adult child, sibling, grandchild, or close friend an “interested person.” Subsection (4)(a) tells those notified to try to agree on the person with a close relationship who is most likely to know the patient’s current wishes. The order of that list does not itself make the spouse first or create a majority vote.

Search and decision process

Under § 15-18.5-103(3), the clinician or designee makes reasonable efforts to notify the patient of the incapacity determination and to locate as many interested persons as practicable. Those found are told a proxy should be selected. The attending physician cannot serve as the proxy under subsection (1.5)(b).

Special treatment limits

Section 15-18.5-103(6)(a) permits a proxy to decide to withhold or withdraw artificial nourishment and hydration only after the attending physician and an independent physician trained in neurology or neurosurgery certify the statute’s dying and recovery findings. The separate physician-proxy fallback has a written-consent and ethics-committee consensus requirement for invasive or significant-risk treatment, and an additional independent physician opinion for certain end-of-life choices (§ 15-18.5-103(4)(c)(V)).

Disagreement and no available person

If an interested person disagrees with selection or a proxy decision, or the group cannot agree on a proxy after reasonable efforts, § 15-18.5-103(4)(a) permits an interested person to seek guardianship. If none can be located or will serve, subsection (4)(c) allows the attending physician to designate a different willing physician only after an independent incapacity finding, medical-ethics committee consensus, and documentation. That physician-proxy authority ends if an interested person agrees to serve, a guardian is appointed, capacity returns, or another listed termination event occurs.

What trips people up

The statute names family members in § 15-18.5-103(1.5) to define who participates in choosing the proxy. It does not put those relationships in priority order. The person selected should have the close relationship and current knowledge of wishes described in subsection (4)(a).

The physician fallback is narrower than the ordinary chosen-person route. Section 15-18.5-103(4)(c) requires an independent capacity assessment and ethics-committee consensus before designation, and further safeguards for some treatment decisions.

Common questions

Can a close friend be chosen? Yes. A close friend is an interested person under § 15-18.5-103(1.5)(a) and can participate in the group’s selection.

What if there is no ethics committee at the treating facility? For physician-proxy safeguards, § 15-18.5-103(4)(c)(II) directs the facility to refer the clinician to a committee at another health-care facility.

Can anyone ask for a fresh capacity assessment? An interested person, guardian, or attending physician who believes capacity has returned can trigger reexamination under § 15-18.5-103(7).

Statutes and sources

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