Colorado Living Will Treatment Preferences: Life Support, Ventilators, and Comfort Care

Colorado's Living Will (officially the "Declaration as to Medical or Surgical Treatment") lets you document specific treatment preferences that take effect after two physicians certify that you have a terminal condition or are in a persistent vegetative state, followed by a mandatory 48-hour waiting period. Understanding exactly what you can control — and what falls outside this document's reach — prevents families from discovering gaps during a crisis.

The Three Artificial Nutrition and Hydration Elections

Colorado's statutory Living Will form requires you to initial one of three options regarding tube feeding and artificial hydration:

• Option A — Remove all artificial nutrition and hydration (feeding tubes withdrawn)
• Option B — Maintain artificial nutrition and hydration for a specified number of days, then withdraw
• Option C — Maintain artificial nutrition and hydration permanently, regardless of prognosis

This election is mandatory for a complete Colorado Living Will. Many generic online forms omit it entirely, which leaves a critical gap — the hospital has no documented guidance on one of the most emotionally difficult decisions families face.

Review this choice while you retain decision-making capacity, especially after a serious diagnosis changes your perspective on comfort vs. prolongation.

Mechanical Ventilation and Life Support

Your Living Will can specify whether you want mechanical ventilation (breathing machines) continued or withdrawn if two physicians certify that you have a terminal condition or are in a persistent vegetative state. Colorado law treats this as part of the broader "life-sustaining procedures" category.

The statutory language defines life-sustaining procedures as "any medical procedure or intervention which, in the judgment of the attending physician, would only serve to prolong the dying process." This includes:

• Mechanical ventilation (breathing machines)
• Cardiac life support (defibrillation, vasopressors)
• Dialysis for kidney failure
• Antibiotics for terminal-phase infections

Note the limitation: these directives apply only when two physicians certify a terminal condition or persistent vegetative state and the mandatory 48-hour waiting period has passed. They do not apply to temporary conditions with reasonable recovery prospects. A Living Will cannot instruct physicians to withdraw ventilation during a recoverable pneumonia.

Comfort Care and Pain Management

Choosing to refuse life-sustaining treatment does not mean refusing comfort. Pain management and palliative measures can continue regardless of your Living Will elections, so you are not choosing between "aggressive treatment" and "suffering."

A comfort-care-only directive tells medical staff to focus exclusively on symptom management: pain medication (including opioids), anti-anxiety medications, oxygen for air hunger, repositioning, and mouth care. You can document this preference in your Living Will, and it is reinforced by selecting "Comfort Measures Only" on a MOST form if you have one.

The distinction matters because some families worry that requesting "no life support" means their loved one will be left in pain. Discuss comfort-focused care with the treating team when reviewing treatment-refusal decisions.

The MOST Form: Clinical-Level Specificity

For patients with advanced illness or frailty, the MOST form (Medical Orders for Scope of Treatment) provides more granular control than the Living Will alone. The MOST form is a medical order signed by an attending physician, APRN, or PA — not a legal directive — that specifies:

• CPR preference (attempt resuscitation vs. do not resuscitate)
• Medical interventions level (full treatment vs. selective treatment vs. comfort measures only)
• Artificial nutrition preferences (long-term feeding, trial period, or none)
• Antibiotics preference (full course vs. comfort-focused only)

The MOST form is designed for individuals whose current medical condition makes these decisions immediately relevant. It is entirely voluntary under C.R.S. § 15-18.7-108 — no facility can require it.

How Living Will and MOST Form Interact

Your Living Will states what you want in the future if you become terminally ill. The MOST form tells medical staff what to do right now given your current condition. The MOST form is an active medical order, while the Living Will states future treatment preferences.

This means your Living Will and MOST form should be consistent. If they conflict (for example, your Living Will refuses artificial nutrition but your MOST form orders it), the medical team faces ambiguity that delays care decisions.

Documenting Values Beyond Checkboxes

Colorado's statutory form covers the major categories, but many families want to communicate values that don't fit neatly into checkbox options. These might include preferences about:

• Being in a familiar environment vs. a clinical setting during final days
• Whether family should be present during treatment withdrawal
• Religious or spiritual rituals during the dying process
• Acceptable quality-of-life thresholds that inform your definitions of "meaningful recovery"

These supplementary preferences aren't legally binding in the same way as the statutory elections, but they guide your healthcare agent's judgment when decisions fall outside the document's explicit instructions.

The Colorado Advance Directive & Living Will Kit walks you through each treatment election with plain-English explanations of what each choice means clinically, so you're making informed decisions rather than checking boxes you don't fully understand.

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