How do I create an advance healthcare directive in Missouri?
1. Types Recognized
Missouri recognizes: (a) Health Care Directive / Living Will (Mo. Rev. Stat. §§ 459.010-459.055), (b) Durable Power of Attorney for Health Care (Mo. Rev. Stat. §§ 404.800-404.870), (c) Outside Hospital DNR (§ 190.600), and (d) Missouri TPOPP (Transportable Physician Orders for Patient Preferences).
2. Statutory Form
Mo. Rev. Stat. § 459.015 contains a Living Will form; § 404.822 provides the DPOA-HC form. Substantial compliance suffices, but form use is encouraged.
3. Execution Formalities
LIVING WILL: 18+ and competent, signed by declarant or at direction, in the presence of TWO adult witnesses or before a notary (§ 459.015). DURABLE POA FOR HEALTH CARE: 18+, signed and NOTARIZED (Mo. Rev. Stat. § 404.705). Witnesses for the living will should not be: heirs/beneficiaries, persons financially responsible for care, attending physician.
4. Healthcare Agent Authority
Under § 404.820, the agent may make healthcare decisions including consent to/refusal of treatment, but to authorize WITHHOLDING/WITHDRAWING ARTIFICIAL NUTRITION OR HYDRATION the document must EXPRESSLY so state (the "Cruzan rule" reflecting Cruzan v. Director, Missouri Dept. of Health, 497 U.S. 261 (1990), 760 S.W.2d 408 (Mo. 1988)).
5. Pregnancy Clauses
Mo. Rev. Stat. § 459.025: a living will is INVALID if the patient is pregnant unless treatment is futile or causes severe harm to the mother. Position remains in force post-Dobbs.
6. Reciprocity
§ 459.045 honors directives valid where executed in compliance with that state's law.
7. TPOPP
Missouri TPOPP is a physician-signed bright-green order portable across care settings, for seriously ill patients (Missouri TPOPP Coalition guidelines).
8. Revocation
Under § 459.020, the directive is revocable at any time, regardless of mental state, by: signed/dated writing, physical destruction, or oral statement to attending physician.
9. Default Surrogate
Missouri has NO statutory surrogate hierarchy. Without a DPOA-HC, decisions for incapacitated patients without clear and convincing evidence of prior wishes (Cruzan standard) may require court-appointed guardianship under Chapter 475.
This is legal information, not legal advice.
- Express ANH authorization required — Cruzan rule
- No surrogate hierarchy — DPOA-HC essential
- Pregnancy provision § 459.025 affecting directive
- Mo. Rev. Stat. §§ 459.010-.055 (Health Care Directive)
- Mo. Rev. Stat. §§ 404.800-.870 (DPOA-HC)
- Cruzan v. Director, Missouri Dept. of Health, 497 U.S. 261 (1990)
This is legal information, not legal advice. Laws vary by jurisdiction and change frequently. Always verify current law with official sources and consult a licensed attorney in your jurisdiction for advice on your specific situation.