Colorado Proxy Decision-Maker Law: What Happens Without a Medical Power of Attorney

Most people assume their spouse or adult child will automatically make medical decisions for them during an emergency. In many states, that assumption is roughly correct — default next-of-kin hierarchies grant decision-making authority in a predictable order.

Colorado is different. The state has no rigid next-of-kin hierarchy for adult medical decisions. Instead, it has the Proxy Decision-Maker Act (C.R.S. § 15-18.5-103), which imposes a consensus requirement that can turn a family's worst day into a legal nightmare.

How the Proxy Process Works

When a Colorado patient loses decision-making capacity and has no Medical Durable Power of Attorney (MDPOA) on file, the attending physician must make reasonable efforts to contact all "interested persons." Under the statute, interested persons include:

• The patient's spouse or civil union partner
• Either parent
• Any adult child
• Any adult sibling
• Any close friend who can demonstrate knowledge of the patient's values

The physician then asks these individuals to agree — unanimously — on who will serve as the patient's proxy decision-maker.

Where It Breaks Down

The consensus requirement sounds reasonable in theory. In practice, it collapses in several common family configurations:

Blended families. A remarried parent may have a current spouse, children from a first marriage, and children from the current marriage. Each adult child is an "interested person" with equal standing. If the current spouse and the ex-spouse's children disagree — which is common when inheritance and caregiving tensions exist — no proxy can be appointed.

Estranged family members. If one sibling has not spoken to the patient in years but is still technically an "interested person," they can block consensus simply by being unreachable or by disagreeing with the other siblings' choice.

Geographic distance. The physician must make "reasonable efforts" to contact all interested persons. If an adult child lives overseas or is traveling, the process stalls while the hospital waits for responses — all while medical decisions are being deferred.

Moral or religious disagreements. Siblings with different beliefs about end-of-life care can deadlock the consensus process indefinitely. One sibling may want aggressive treatment while another favors comfort care, and the statute gives neither one priority over the other.

When Consensus Fails: Guardianship Court

If interested persons cannot reach unanimous agreement, the family's only option is to file a petition in the local district court for a formal guardianship hearing. This process involves attorney fees for the petitioner (typically $3,000-$10,000), court filing fees ($229 for a standard probate filing in Colorado), a potential court-appointed investigator or guardian ad litem, and waiting weeks or months for a hearing date while medical decisions remain in limbo.

In contested cases, the court may appoint a professional guardian — a neutral third party who has never met the patient — to make healthcare decisions. Professional guardians charge hourly fees that the patient's estate must pay.

This entire process exists because one document — the MDPOA — was never signed.

What an MDPOA Prevents

A signed Medical Durable Power of Attorney under C.R.S. § 15-14-501 completely bypasses the proxy consensus process. It names one person with unambiguous authority to make medical decisions. That person does not need anyone else's agreement. Siblings, parents, and estranged family members have no legal standing to override the appointed agent's decisions.

The MDPOA also designates alternate agents — so if the primary agent is unreachable, the alternate steps in immediately. No physician outreach. No consensus polling. No court petition.

The Emergency Exception

Colorado does not leave patients completely unprotected when no proxy can be identified. Under the standard of care, physicians can make emergency treatment decisions necessary to preserve life when no authorized decision-maker exists. But this authority is narrow — it covers immediate life-threatening situations, not ongoing treatment planning, facility transfers, or decisions about whether to continue life support.

For any non-emergency medical decision, the consensus process applies. And "non-emergency" includes most of the decisions that matter: whether to proceed with a recommended surgery, whether to transfer to hospice, whether to continue chemotherapy, and whether to adjust medications.

Protect Your Family From the Consensus Trap

The Colorado Advance Directive & Living Will Kit includes MDPOA templates that name your agent and alternates, removing the need for proxy consensus entirely. It takes about 15 minutes to complete — far less time, cost, and emotional damage than a guardianship petition in probate court.

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