Montana Advance Directive Registry and Living Will: How to File and Access

A living will or advance healthcare directive only works if it can be found when it is needed. The most common reason these documents fail to achieve their purpose is not that they were never created — it is that nobody could locate them during a medical emergency.

Montana addressed this problem by creating the Montana End-of-Life Registry, a centralized, secure database that stores advance directives so healthcare providers can access them around the clock. Understanding how this registry works matters both for individuals who want to register their own directives and for families who need to check whether a deceased or incapacitated loved one had documented wishes on file.

What the Montana End-of-Life Registry Is

The Montana End-of-Life Registry is managed by the Office of the Attorney General within the Montana Department of Justice. It is a free, centralized database that stores:

• Advance healthcare directives relating to life-sustaining treatment (including living wills and declarations naming a healthcare decision-maker)
• The registry is distinct from POLST forms (Provider Orders for Life-Sustaining Treatment), which are physician-signed medical orders; ask the treating provider how a POLST is handled alongside a registered directive

The registry is accessible 24 hours a day, 7 days a week, to registered healthcare providers and to the registrant or another authorized person with the required access information. This is the specific problem it solves: a patient arrives unconscious at an emergency room at 2 a.m. on a Sunday, and without the registry, a physician may have no way to know whether that patient wanted aggressive intervention or comfort-focused care.

What an Advance Directive Does

An advance directive allows an individual — while competent — to specify:

• What life-sustaining treatments they want or do not want (ventilators, CPR, feeding tubes, dialysis)
• Under what conditions treatments should be withheld or withdrawn
• Who should make healthcare decisions on their behalf if they become unable to do so (a healthcare proxy or agent under a durable power of attorney for healthcare)

Montana law recognizes these documents. When a valid declaration has been communicated and is operative because the patient is terminal and unable to make treatment decisions, healthcare providers must follow it. A hospital that ignores an operative Montana advance directive is acting contrary to the patient's legal rights and state law.

The advance directive is different from a POLST form. The advance directive is a patient-created legal document expressing preferences. The POLST is a physician's order — a medical order that translates the patient's wishes into specific treatment instructions in the clinical record. A POLST is typically used for patients who are seriously ill or frail and need their care preferences translated into actionable medical orders that travel with them between care settings.

How to Register a Directive in Montana

Registering an advance directive with the Montana End-of-Life Registry is voluntary. The registry does not require registration — a valid advance directive is legally effective whether or not it is registered. But registration dramatically increases the likelihood that the document will be found and followed.

To register:

1. Execute a valid advance directive. Montana has no specific required form for a declaration — it must be signed by the declarant (or at the declarant's direction) and witnessed by two individuals. Montana does not require notarization for this declaration.

2. Submit the document to the registry. Mail the directive with the Montana End-of-Life Consumer Registration Agreement to the Office of Consumer Protection, Department of Justice. Directives cannot be filed electronically; current mailing instructions are available through the Montana Department of Justice website.

3. Provide the registry information to family members and physicians. The registered person should inform their primary care physician that the directive is registered, and ensure that the designated healthcare proxy knows how to access it.

How Healthcare Providers Access the Registry

When a patient arrives at a healthcare facility in a condition where an advance directive may be relevant, a registered provider can access the registry using the patient's authorized identifying information and provider credentials. A registrant or authorized person generally needs the name and access code or other required identifying information. The registry provides the stored document or confirms that no document is on file.

The registry's value is highest in emergency situations — when the patient is unconscious, when family members cannot be reached quickly, or when the patient is transferred between facilities and paper documents are not traveling with them.

Updating or Revoking a Directive

The most recently dated advance directive supersedes all prior documents. If a person has changed their wishes — often the case after a major health event or change in family circumstances — they can:

1. Execute a new written advance directive
2. Communicate the revocation to the attending physician, attending advanced practice registered nurse, or other healthcare provider. Montana permits revocation at any time and in any manner, but the revocation must be communicated to take effect for care.
3. Submit the updated document to the registry to replace the prior version

A newer valid advance directive may supersede an earlier one. A POLST is a separate medical order, so ask the treating provider how it interacts with the directive. Healthcare providers are required to honor an operative, valid directive.

The Role of Advance Directives in Estate Settlement

Advance directives deal with medical decisions made before or at the time of death — they are not estate planning documents and they do not affect how property is distributed. A living will cannot designate beneficiaries or transfer property.

However, the existence (or absence) of an advance directive affects the first hours of estate settlement. In the immediate aftermath of a death, if there is any uncertainty about whether the decedent had documented end-of-life preferences, checking the Montana End-of-Life Registry is the right first step. This is particularly important when family members disagree about whether aggressive measures should have been pursued, or when there are questions about treatment decisions made in the final days.

For families where the question is about disposition of the remains — burial versus cremation, who has authority to make that call — that is governed by the Montana Right of Disposition Act, not by the advance directive or the living will.

Practical Steps for Families

If you are registering your own directives:

• Execute an advance directive that specifically identifies your healthcare proxy and your treatment preferences
• Submit to the registry
• Give copies to your primary physician, your healthcare proxy, and a trusted family member
• Make sure your healthcare proxy knows how to contact the registry

If you are checking whether a deceased loved one had a registered directive:

• Contact the Montana End-of-Life Registry through the Department of Justice
• Providers at any treating facility may also be able to confirm whether a POLST or registered directive was on file

The Montana Estate Settlement Guide covers the complete sequence for administering a Montana estate — from the immediate decisions that happen in the first 48 hours through the final distribution of assets months later. Advance directives are part of what must be located and reviewed in those first hours; the estate settlement process itself begins immediately after.

See more Montana guides →