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Medical Power of Attorney in Missouri: The Health Care Power of Attorney and Living Will
Missouri's medical power of attorney follows the state's durable power of attorney rules, including a notary, while its living will needs two witnesses and no notary. Here is how both work.
By naveen · Updated · How we research our guides
What to know
- Missouri's Durable Power of Attorney for Health Care Act applies the general durability rule, so a health care power of attorney is durable only if it carries the durable title and statement and is signed, dated and notarized (RSMo 404.810, 404.705).
- Unless the document says otherwise, the agent's authority starts when two physicians certify that your parent is incapacitated (RSMo 404.825).
- A Missouri living will, called a declaration, needs two adult witnesses unless it's entirely in your parent's handwriting, and no notary (RSMo 459.015).
- The Missouri health care statutes we read don't set a priority list of relatives who can decide if there's no document.
- Retirement Checklist puts these documents in order alongside everything else your family needs to settle.
A Missouri medical power of attorney, a durable power of attorney for health care, names an agent for your parent's health care decisions and needs the durable title, a durability statement and a notary. The act is RSMo 404.800 to 404.872, and its execution rules come from the state's general power of attorney law: RSMo 404.810 applies section 404.705, which makes a power of attorney durable only if it's titled a durable power of attorney, includes a durability statement, and "is subscribed by the principal, and dated and acknowledged in the manner prescribed by law for conveyances of real estate."
What is a durable power of attorney for health care in Missouri?
It's a document in which your parent names an agent, called an attorney in fact, to make health care decisions when your parent can't. The law is the "Durable Power of Attorney for Health Care Act." The agent "has the same right as the patient to receive information regarding the proposed health care, to receive and review medical records and to consent to the disclosure of medical records" (RSMo 404.840).
A financial power of attorney can also include health care authority if it says so expressly; see our Missouri power of attorney guide.
How is it different from a living will?
A health care power of attorney names someone to decide for your parent, while a living will gives your parent's own direction about death-prolonging procedures in a terminal condition.
| Document | What it does | Signing rule |
|---|---|---|
| Durable power of attorney for health care | Names an agent for health care decisions when your parent is incapacitated | Durable title and statement, signed, dated and acknowledged before a notary (RSMo 404.705, via 404.810) |
| Declaration (living will) | Directs withholding or withdrawing death-prolonging procedures if your parent has a terminal condition | In writing, signed and dated; two adult witnesses unless wholly handwritten (RSMo 459.015) |
No power of attorney can let an agent make or revoke a living will for your parent; your parent signs that themselves. For the general picture, see power of attorney vs. advance directive.
How do you sign a Missouri health care power of attorney?
Because section 404.705 applies, the document should be titled a durable power of attorney, contain the statute's durability statement, and be signed, dated and acknowledged before a notary or another officer who can take acknowledgments for real estate. The sections we read, RSMo 404.800 to 404.872, don't require witnesses and don't print a form.
Two rules protect your parent's choice. It's unlawful for a provider "to require an individual to execute a durable power of attorney for health care as a condition for the provision of health care services or admission to a health care facility." And a copy goes into the medical record once a provider learns of it.
Who can't serve as the health care agent?
Under RSMo 404.815, these people can't serve unless they're related to your parent within the second degree, or belong to the same religious community bound by vows:
- your parent's attending physician or an employee of the attending physician;
- an owner, operator or employee of a health care facility where your parent lives.
The general disqualifications from serving as a guardian or conservator also apply, such as being under 18. If your parent names their spouse, filing for divorce ends the spouse's authority unless the document says otherwise.
When does the agent start making decisions?
Unless your parent's document says otherwise, the agent's powers "shall commence upon a certification by two licensed physicians based upon an examination of the patient that the patient is incapacitated" (RSMo 404.825). One may be the attending physician, and the powers stop when a physician certifies your parent is no longer incapacitated.
Some limits apply. To withhold or withdraw artificially supplied nutrition and hydration, "the patient shall specifically grant such authority in the power of attorney." The agent must consider your parent's diagnosis, prognosis, and the benefits and burdens of treatment, and "shall consider appropriate measures in accord with current standards of medical practice to provide comfort to the patient."
How do you sign a Missouri living will?
Under RSMo 459.015, a declaration must be in writing, signed by your parent or by someone in their presence at their direction, and dated. "If not wholly in the declarant's handwriting," it must be signed before two or more witnesses at least 18 years old, and the person who signed for your parent can't be a witness. The statute prints a sample form, but "it shall not be necessary to use this sample form."
It applies "only if the declarant's condition is determined to be terminal and the declarant is not able to make treatment decisions." Under Missouri's definition, death-prolonging procedures don't include comfort care, pain relief, or "any procedure to provide nutrition or hydration." Your parent is responsible for letting the attending physician know the declaration exists.
What happens if your parent has no health care power of attorney?
The Missouri health care statutes we read, RSMo 404.800 to 404.872 and chapter 459, don't set a priority list of relatives who can make decisions for an incapacitated adult. Chapter 459 says it "shall create no presumption concerning the intention of an individual who has not executed a declaration."
Without an agent, a family may need a court-appointed guardian, described in our Missouri guardianship guide. Naming an agent is how your parent chooses who decides.
How do you revoke a Missouri advance directive?
Your parent can revoke either one at any time, in any manner they can communicate.
- Health care power of attorney. It "may be revoked at any time and in any manner by which the patient is able to communicate the intent to revoke," effective once communicated to the agent, the attending physician or a provider (RSMo 404.850). A newer health care power of attorney revokes an older one unless it says otherwise.
- Living will. It "may be revoked at any time and in any manner by which the declarant is able to communicate his intent to revoke, without regard to mental or physical condition" (RSMo 459.020).
What about do-not-resuscitate orders?
Missouri's Outside the Hospital Do-Not-Resuscitate Act lets your parent, or their health care agent once your parent is incapacitated, sign a do-not-resuscitate order with the attending physician on a state health department form. It tells emergency medical services personnel not to perform CPR outside a hospital, and it doesn't cover other treatment such as oxygen or intravenous fluids. EMS won't follow it if your parent asks to be resuscitated.
Frequently asked questions
Does a medical power of attorney need to be notarized in Missouri?
To be durable, yes. RSMo 404.810 applies the durability rule in section 404.705, which requires the durable title and statement and a signature that's dated and acknowledged as for a real estate deed, which a notary can take. A Missouri living will is different: it needs two witnesses, not a notary.
Who can witness a living will in Missouri?
Any two people at least 18 years old, except the person who signed the declaration on your parent's behalf. The witnesses aren't needed if your parent writes the declaration entirely by hand. Chapter 459's sample form has the witnesses state that your parent is known to them, is of sound mind and signed voluntarily.
Where can I get a Missouri medical power of attorney form?
The Durable Power of Attorney for Health Care Act doesn't print a form. RSMo 459.015 includes a sample living will declaration, and RSMo 459.016 directs the state health department to post an advance directive form on its website. An attorney can draft a health care power of attorney with the required durable wording.
Who makes medical decisions in Missouri if there's no power of attorney?
The Missouri health care statutes we read don't list relatives who can decide by default. If your parent is incapacitated with no agent and no applicable living will, a court-appointed guardian may be needed. Naming a health care agent in a notarized durable power of attorney lets your parent choose instead.
Is there a Missouri advance directive registry?
Missouri law directs the state health department to contract with a third party for an online Advance Health Care Directives Registry, with a submission fee of no more than ten dollars. Registering is optional: "Failure to register a document with the registry maintained under this section shall not affect the document's validity."
Can my parent change their mind after signing?
Yes. Your parent can revoke a health care power of attorney at any time, in any manner they can communicate, by telling the agent, the attending physician or a provider. A living will can be revoked at any time and in any manner, regardless of your parent's mental or physical condition.
Getting started
A health care power of attorney only helps if it's signed while your parent can sign it, with the durable wording and a notary, and if the doctor and agent have copies. The plan this site builds asks four questions, including which state your parents live in, and puts the steps that matter most for your family in order. It's free and takes about 90 seconds.
Related guides
Sources
- RSMo chapter 404, Durable Power of Attorney for Health Care Act: applicable rules (404.810), who can't serve (404.815), nutrition and hydration (404.820), when authority begins (404.825), medical records (404.840) and revocation (404.850), with the durability rule in 404.705; published by the Missouri Revisor of Statutes.
- RSMo chapter 459, Declarations, Life Support: definitions (459.010), signing and the sample form (459.015), the health department form (459.016), revocation (459.020), when it applies (459.025) and the registry (459.250).
- RSMo chapter 190, Outside the Hospital Do-Not-Resuscitate Act: sections 190.600 to 190.621.
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