COLORADO ADVANCE HEALTH CARE DIRECTIVE
(a/k/a “Living Will”)
[// GUIDANCE: This template is drafted to comply with the Colorado Medical Treatment Decision Act, C.R.S. §§ 15-18-101 et seq., and incorporates additional best-practice provisions that go beyond the statutory minimums. Bracketed text and ALL-CAPS placeholders must be customized before use. Remove all guidance comments prior to final execution.]
TABLE OF CONTENTS
- Document Header
- Definitions
- Operative Provisions
3.1 Statement of Intent
3.2 Specific Treatment Instructions
3.3 Pregnancy Provision
3.4 Organ & Tissue Donation - Representations & Warranties
- Covenants & Restrictions
- Default & Remedies
- Risk Allocation
- Dispute Resolution
- General Provisions
- Execution Block
1. DOCUMENT HEADER
Advance Health Care Directive (Living Will)
Date: [DATE]
Declarant: [FULL LEGAL NAME], residing at [ADDRESS] (“Declarant”)
Recitals
A. Declarant is an adult of sound mind who desires to make advance decisions regarding medical treatment pursuant to C.R.S. §§ 15-18-101 et seq.
B. Declarant intends this instrument to constitute a “Declaration as to Medical or Surgical Treatment” under C.R.S. § 15-18-104 and any successor statute.
C. This Directive becomes effective only as provided by law when the Declarant has been determined by two physicians to be in a terminal condition or in a persistent vegetative state, and unable to make or communicate medical decisions.
2. DEFINITIONS
For purposes of this Directive, the following capitalized terms shall have the meanings set forth below:
“Artificial Nutrition and Hydration” – The medical provision of food and fluids via intravenous, gastrostomy, or nasogastric tube.
“Attending Physician” – The physician who has primary responsibility for the care and treatment of the Declarant.
“Directive” – This Colorado Advance Health Care Directive, including all attachments and duly-executed amendments.
“Persistent Vegetative State” – A condition of permanent and irreversible unconsciousness in which thought, sensation, purposeful action, social interaction, and awareness of self and environment are absent, as certified in writing by two physicians.
“Terminal Condition” – An incurable or irreversible condition for which administration of life-sustaining procedures will only postpone the moment of death, as certified in writing by two physicians.
[// GUIDANCE: Add or delete definitions as necessary to align with client preferences and medical terminology.]
3. OPERATIVE PROVISIONS
3.1 Statement of Intent
Declarant directs that the provisions herein shall be carried out in good faith by health-care providers, family members, and any named health-care agent, and affirms that:
a. This Directive is made voluntarily and without duress;
b. Declarant understands its full import; and
c. Declarant desires to avoid prolongation of the dying process by extraordinary measures when there is no reasonable expectation of recovery.
3.2 Specific Treatment Instructions
If I (Declarant) am determined to be in a Terminal Condition or Persistent Vegetative State and lack decisional capacity, the following instructions apply:
a. Cardiopulmonary Resuscitation (CPR):
☐ I DO want CPR attempts.
☐ I DO NOT want CPR attempts.
b. Mechanical Ventilation:
☐ Continue ventilation as needed.
☐ Discontinue/withhold ventilation.
c. Artificial Nutrition and Hydration:
☐ Provide even if other treatments are withheld.
☐ Withhold/withdraw if other life-sustaining procedures are withheld.
d. Dialysis, Antibiotics, and Other Life-Sustaining Procedures:
☐ Continue all indicated treatments.
☐ Withhold/withdraw if futile.
[// GUIDANCE: Statute permits either blanket refusal or conditional acceptance. Customize selections with the client.]
3.3 Pregnancy Provision
If I am pregnant and it is probable that the fetus could develop to the point of live birth with continued application of life-sustaining procedures, I direct as follows (check one):
☐ Sustain my life to preserve the pregnancy.
☐ Follow my treatment instructions above regardless of pregnancy.
☐ Defer to my named health-care agent’s decision.
3.4 Organ & Tissue Donation
Upon my death, I grant the following anatomical gifts:
☐ Any organs/tissues needed.
☐ Only the following: [SPECIFY].
☐ None.
4. REPRESENTATIONS & WARRANTIES
4.1 Capacity. Declarant represents that he/she is at least eighteen (18) years of age and of sound mind.
4.2 Voluntariness. Execution of this Directive is voluntary; no party has exerted undue influence.
4.3 Revocability. Declarant understands the right to revoke this Directive at any time pursuant to C.R.S. § 15-18-109.
5. COVENANTS & RESTRICTIONS
5.1 Health-Care Providers’ Covenant. Providers shall honor this Directive in accordance with C.R.S. §§ 15-18-106 and 107, subject to conscience objections, emergency exceptions, or transfer duties under law.
5.2 Declarant’s Covenant. Declarant agrees to inform relevant persons of any revocation or amendment.
5.3 Restrictions.
a. This Directive shall not be construed to authorize assisted suicide or mercy killing.
b. No provision herein excuses providers from standards of ordinary care applicable under Colorado law.
6. DEFAULT & REMEDIES
6.1 Event of Default. Failure of a provider or surrogate decision-maker to comply with this Directive after actual notice constitutes a material default.
6.2 Notice & Cure. Declarant (or interested person) shall provide written notice of non-compliance to the defaulting party, who shall have twenty-four (24) hours to cure, subject to emergent medical circumstances.
6.3 Remedies.
a. Injunctive Relief. Interested persons may petition a court of competent jurisdiction for immediate injunctive relief to enforce or enjoin acts inconsistent with this Directive.
b. Costs & Fees. The court may award reasonable attorney fees and costs to the prevailing party who acts to uphold the Declarant’s expressed wishes.
[// GUIDANCE: While litigation over directives is rare, these provisions deter non-compliance.]
7. RISK ALLOCATION
7.1 Provider Protection (Indemnification). To the fullest extent allowed by law, Declarant (and Declarant’s estate) releases and agrees to indemnify health-care providers from civil or criminal liability arising from good-faith reliance on this Directive, except for gross negligence or willful misconduct.
7.2 Limitation of Liability. No provider acting in good faith pursuant to C.R.S. § 15-18-113 shall incur liability beyond the limits set forth therein (“Good-Faith Standard”).
7.3 Insurance. Providers remain responsible for maintaining professional liability coverage as required by law; nothing herein reduces such obligations.
8. DISPUTE RESOLUTION
8.1 Governing Law. This Directive and any controversy arising hereunder shall be construed in accordance with the substantive laws of the State of Colorado (“state_healthcare_law”).
8.2 Forum Selection & Arbitration. Not applicable.
8.3 Jury Waiver. Not applicable.
8.4 Preservation of Injunctive Relief. Nothing in this Section shall limit the right of any party to seek emergent injunctive or declaratory relief to enforce healthcare decisions consistent with Section 6.3.
9. GENERAL PROVISIONS
9.1 Amendment. Declarant may amend this Directive at any time by executing a written amendment signed by Declarant and two (2) qualifying witnesses.
9.2 Revocation. Pursuant to C.R.S. § 15-18-109, Declarant may revoke this Directive by:
a. A signed, dated writing;
b. Physical destruction of the original document; or
c. An oral expression of intent to revoke, communicated to the Attending Physician, who shall document same in the medical record.
9.3 Severability. If any provision is held invalid, the remaining provisions shall remain in full force to the maximum extent permissible.
9.4 Integration. This Directive supersedes all prior directives executed by Declarant concerning the same subject matter.
9.5 Copies & Electronic Signatures. Photostatic or electronically signed copies of this Directive shall be as valid as an original.
10. EXECUTION BLOCK
IN WITNESS WHEREOF, Declarant executes this Advance Health Care Directive on the date first written above.
Declarant:
[SIGNATURE]
[PRINTED NAME]
QUALIFYING WITNESSES
Each witness must be at least eighteen (18) years old, not related to Declarant by blood, marriage, or adoption, not entitled to any portion of Declarant’s estate, and not directly involved in Declarant’s medical care.
-
Signature of Witness
Printed Name: _____
Address: ____
Date: _______ -
Signature of Witness
Printed Name: _____
Address: ____
Date: _______
[// GUIDANCE: Colorado does NOT require notarization, but a notary block is recommended for interstate recognition.]
OPTIONAL NOTARIZATION
State of Colorado )
County of ____ ) ss.
Subscribed, sworn to, and acknowledged before me by [DECLARANT NAME], the Declarant, and [WITNESS 1] and [WITNESS 2], witnesses, this _ day of _, 20__.
Notary Public
My commission expires: ____
[// GUIDANCE: After execution, provide copies to the Declarant’s physician(s), health-care agent(s), and close family members, and consider uploading to the Colorado Advance Directive Registry (if available).]