Montana: Living Will and Advance Health-Care Instruction Requirements
The short answer
Montana's Rights of the Terminally Ill Act lets a person age 18 or older and of sound mind execute a signed declaration, personally or through a directed signer, with two witnesses; notarization is not an alternative under the Act. The declaration becomes operative only after it reaches the attending physician or advanced practice registered nurse and that clinician determines both a terminal condition and loss of decision-making ability. It may direct withholding or withdrawal of treatment that only prolongs dying, while comfort care remains; pregnancy prevents withdrawal while probable live birth remains possible, and the declaration may be revoked at any time and in any manner regardless of mental or physical condition.
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This is the general rule in Montana. Ezel applies current Montana law to your specific facts and answers with citations to the statutes.
| Governing law and document | Montana Rights of the Terminally Ill Act, MCA tit. 50, ch. 9. Standalone 'declaration' governs withholding/withdrawal of life-sustaining treatment and may also designate another adult for those decisions (§§ 50-9-102, -103). Optional statutory forms; separate from general health-care POA and EMS living-will protocols |
|---|---|
| Who may make an instruction | Individual age 18+ and of sound mind may execute anytime (§ 50-9-103(1)). A designee for withholding/withdrawal decisions must also be age 18+ and of sound mind. 'Qualified patient' is age 18+, has compliant declaration, and is determined terminal (§ 50-9-102(13)) |
| Oral, written, and signature form | Written document signed by declarant or another at declarant's direction (§§ 50-9-102(5), -103(1)). Statutory forms are optional and include date/residence lines, but operative execution sentence does not require a date. No oral creation or electronic-specific execution route in chapter 9 |
| Witness, notary, and disqualifications | Exactly 2 witnesses required (§ 50-9-103(1)); Act states no minimum witness age, relationship, inheritance, provider, facility, or designee disqualification. Notarization is not an alternative to the 2 witnesses. Provider may presume validity absent actual contrary notice |
| Covered conditions and trigger | Declaration operates only when communicated to attending physician/APRN and that clinician determines terminal condition plus inability to decide about life-sustaining treatment (§ 50-9-105). Terminal means incurable/irreversible condition expected to cause death relatively soon without treatment; life-sustaining treatment then only prolongs dying (§ 50-9-102). One attending clinician determines; no PVS/end-stage route |
| Treatment, nutrition, hydration, and comfort | Declaration governs withholding/withdrawal of life-sustaining treatment that only prolongs dying; optional form excludes treatment necessary for comfort or pain relief (§ 50-9-103). Providers remain responsible for comfort/pain treatment, including nutrition and hydration (§ 50-9-202(2)). Act provides no separate artificial-nutrition/hydration election |
| Pregnancy and other statutory limits | No withholding/withdrawal under declaration when attending clinician knows patient is pregnant while continued treatment probably permits fetal development to live birth (§ 50-9-202(3)). Organ-suitability measures continue unless donor's directive expressly says otherwise (§ 72-17-216). Chapter does not authorize mercy killing/euthanasia or require action contrary to reasonable medical standards (§ 50-9-205) |
| Revocation, notice, and registry | Revoke anytime/in any manner regardless of mental/physical condition; effective on communication to attending clinician/provider under § 50-9-104's recipient rules, and provider records it. Optional AG registry stores filed declarations; nonfiling and failure to notify registry of revocation do not affect validity, and AG removes declaration on revocation notice (§§ 50-9-501–503) |
| Provider duties, recognition, and effect | Provider given copy records it and promptly advises declarant/designee if unwilling (§ 50-9-103(5)); attending clinician records terminal finding/terms, complies when operative or promptly transfers, and facility transfers if policy bars compliance (§§ 50-9-201, -203). Statutory immunity (§ 50-9-204); no duty to search registry (§ 50-9-502). Substantially similar declaration valid where made is recognized (§ 50-9-111) |
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Montana uses a standalone declaration under the Rights of the Terminally Ill
Act, Mont. Code Ann. title 50, chapter 9. The declaration addresses
withholding or withdrawal of life-sustaining treatment in a terminal condition.
It is separate from a general durable health-care power of attorney and from an
emergency-services living-will protocol.
Requirements one by one
The declaration needs a signature and two witnesses
Under § 50-9-103(1), the declarant must be at least 18 and of sound mind.
The declarant signs personally or directs another person to sign, and two
individuals must witness the declaration. The Act does not make notarization an
alternative and does not list witness-age, relationship, inheritance, provider,
facility, or designee disqualifications.
The two printed forms in § 50-9-103 are optional. They include a date,
signature, residence, and two witness blocks, but the subsection's operative
execution sentence does not separately require a date. Chapter 9 states no oral
creation route or electronic-specific execution method.
One attending clinician makes both activating findings
The declaration becomes operative only when it has been communicated to the
attending physician or attending advanced practice registered nurse and that
clinician determines both that the declarant has a terminal condition and can
no longer decide about life-sustaining treatment (§ 50-9-105).
A terminal condition is incurable or irreversible and, without life-sustaining
treatment, is expected by the attending clinician to cause death relatively
soon. Covered treatment is a procedure or intervention that would serve only to
prolong the dying process (§ 50-9-102). The Act does not add a permanent-
unconsciousness or persistent-vegetative-state route.
Comfort treatment, including feeding, remains
The optional direct-instruction form tells the clinician to withhold or withdraw
treatment that only prolongs dying and is not necessary for comfort or pain
relief. Section 50-9-202(2) preserves the provider's responsibility to give
treatment, including nutrition and hydration, for comfort care or alleviation
of pain.
The Act does not print a separate artificial-nutrition-or-hydration election.
Its treatment direction and the comfort-care rule must be read together rather
than turning feeding into an automatic all-or-nothing choice.
What trips people up
- Pregnancy uses a probable-live-birth test. Life-sustaining treatment may
not be withheld or withdrawn under the declaration while the attending
clinician knows the patient is pregnant and continued treatment probably
would allow the fetus to develop to live birth (§ 50-9-202(3)). - Organ-preservation measures need an express contrary instruction. If the
prospective donor is in a health care facility, measures needed to preserve
organ suitability may not be withheld or withdrawn unless the declaration
expressly says otherwise (§ 72-17-216). - Registry filing is optional. § 50-9-501, § 50-9-502, and
§ 50-9-503 establish the
Attorney General's registry, but failure to file does not affect declaration
validity and failure to notify the registry does not invalidate a revocation.
Providers are not required to search it.
Common questions
May a notary replace the two witnesses?
No. § 50-9-103(1) requires the declaration to be witnessed by two
individuals and states no notarial alternative.
Can I revoke after losing capacity?
The statute says a declarant may revoke at any time and in any manner, without
regard to mental or physical condition. Effectiveness depends on communication
under § 50-9-104, and the provider records the revocation.
What if the provider or facility will not comply?
The provider must take all reasonable steps as promptly as practicable to
transfer care to a willing provider. A facility whose policy prevents
compliance must take all reasonable steps to transfer the patient to a facility
that can carry out the Act (§ 50-9-203). § 50-9-204 supplies the
chapter's stated immunity for qualifying conduct, while § 50-9-205 preserves
reasonable medical standards and does not authorize mercy killing or euthanasia.
Will Montana recognize a declaration made elsewhere?
An out-of-state declaration is effective for chapter 9 if it was made in a
manner substantially similar to § 50-9-103 and complies with the law of the
state where it was executed (§ 50-9-111).
Statutes and sources
- Mont. Code Ann. §§ 50-9-102–105 — definitions, execution, optional forms,
revocation, notice, and operative trigger. Montana Legislature, MCA 2025
(accessed 2026-07-31). - Mont. Code Ann. § 50-9-111 — out-of-state declarations. Same official
source (accessed 2026-07-31). - Mont. Code Ann. §§ 50-9-201–205 — recordkeeping, current patient choice,
comfort care, pregnancy, transfer, immunity, insurance, and statutory limits.
Same official source (accessed 2026-07-31). - Mont. Code Ann. §§ 50-9-501–503 — optional declaration registry, filing,
access, and removal. Same official source (accessed 2026-07-31). - Mont. Code Ann. § 72-17-216 — organ-suitability measures and express
contrary directions. Same official source (accessed 2026-07-31).
Source links
Every statute quoted above, linked, with the date we checked it.
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