Montana End of Life Registry: How It Works and Who Can Access It

When someone is critically ill or approaching death, the people around them — family members, emergency responders, hospital staff — often have no idea whether a living will exists, who holds healthcare decision-making authority, or what the person wanted regarding life-sustaining treatment. Paper documents get lost in filing cabinets, locked in safes no one can access, or simply never found until it is too late.

Montana created a centralized solution: the Montana End of Life Registry. If you are trying to find a deceased person's advance directive, or if you want to register your own so it is accessible in a medical emergency, this is what you need to know.

What the Montana End of Life Registry Is

The Montana End of Life Registry is a free, secure, centralized database managed by the Office of the Attorney General within the Montana Department of Justice. Its purpose is to store advance healthcare directives for Montana residents in a place where healthcare providers can retrieve them at any hour.

The registry stores:

• Advance healthcare directives (living wills)
• Declarations regarding life-sustaining treatment
• Healthcare proxy designations (durable power of attorney for healthcare)
• POLST (Provider Orders for Life-Sustaining Treatment) forms

All documents stored in the registry remain under the control of the individual who registered them. Registration is voluntary, not mandatory.

Who Can Access the Registry

The registry is available 24 hours a day, seven days a week, for authorized users — specifically healthcare providers treating the individual. This includes emergency room physicians, paramedics, hospice workers, nursing facility staff, and other licensed healthcare professionals involved in a patient's care.

Family members generally cannot independently access the registry to retrieve a relative's directive without going through the healthcare provider involved in the person's care. The registry is designed as a healthcare coordination tool, not a public records database.

This means that in a medical emergency, the treating provider can look up the patient's directive in real time — without needing to contact family members, search through the home, or wait for paperwork to be located.

How to Register an Advance Directive

To register an advance directive with the Montana End of Life Registry, the document must already exist — registration stores the directive, it does not help you create one. If you do not yet have an advance directive, you would create it first (often with assistance from an attorney or through a Montana legal aid form), and then register it.

Registration is done through the Office of the Attorney General. The process involves submitting the signed, executed document to the registry for secure storage. The registry does not validate the legal sufficiency of the document — it simply stores and makes available what you submit.

There is no filing fee for the Montana End of Life Registry.

POLST Forms and Their Relationship to the Registry

A POLST form (Provider Orders for Life-Sustaining Treatment) is different from an advance directive, though both deal with end-of-life medical preferences. An advance directive is a planning document you create ahead of time, expressing your wishes. A POLST is a medical order signed by a physician that translates those wishes into specific, immediately actionable instructions for healthcare providers.

POLST forms are particularly relevant for people with serious illness or advanced age who want their care preferences honored across all settings — including emergency situations where advance directives might not be immediately actionable without additional physician involvement.

The Montana End of Life Registry can store POLST forms as well as traditional advance directives. If a patient or their designated healthcare decision-maker wishes to modify or revoke a POLST form, they can do so by executing a new written directive or formally voiding the existing document. Under Montana law, the most recently dated directive supersedes all prior instructions.

What the Registry Does Not Do

The registry does not make medical decisions. It does not determine whether life-sustaining treatment is appropriate. It does not override the judgment of treating physicians. It simply makes the person's expressed wishes accessible to those making medical decisions so that those wishes can inform — and in some cases control — the care decisions being made.

The registry also does not resolve disputes among family members about end-of-life care. If family members disagree about whether to continue treatment, or dispute whether a directive accurately reflects the person's wishes, that conflict must be resolved through the healthcare facility's ethics processes or, in extreme cases, through the courts.

Finding an Advance Directive When Someone Has Already Died

In the context of estate settlement, families sometimes look for an advance directive not to make medical decisions (that moment has passed) but to understand what documents existed and whether there are any post-death instructions embedded in them. Advance directives sometimes include preferences about organ donation, which can be relevant immediately after death.

Organ donation preferences are also registered separately through the Montana Driver License Division when obtaining or renewing a driver's license or state ID. If the person's license indicates they are a registered organ donor, that information was already captured at the time of licensing. Funeral homes and hospital staff are typically informed by the family or by checking the license.

For estate settlement purposes, the more important documents to locate after a death are:

• The original will
• Trust documents
• Beneficiary designation forms for retirement accounts and life insurance
• Transfer on Death deeds for real estate

The advance directive is relevant in the medical context preceding death; the estate planning documents govern what happens to property and assets afterward.

Including Advance Directive Wishes in Estate Planning

If you are helping a family member or doing your own estate planning, the Montana End of Life Registry is a valuable tool — but it is one piece of a larger puzzle. An advance directive specifies healthcare wishes; a separate durable power of attorney for healthcare designates who makes decisions if you cannot; a financial power of attorney designates who handles financial affairs during incapacity; and a will or trust governs what happens to property after death.

Each document serves a different function, and none substitutes for the others.

For families who are working through estate settlement after a death in Montana — including the full range of tasks from ordering death certificates to navigating probate to distributing assets — the Montana Estate Settlement Guide provides the complete step-by-step process organized by timeline, with the specific forms and deadlines required at each stage.

Practical Steps for Families in the First 48 Hours

If a death has just occurred and you are trying to determine what end-of-life instructions existed:

1. Check the decedent's personal files and safe deposit box for a physical copy of any advance directive.
2. If the person died in a hospital or care facility, ask the treating physician or nursing staff whether any directive was on file with the facility or retrieved from the registry during the course of care.
3. Contact the decedent's primary care physician to inquire whether a POLST form or advance directive was part of their medical record.
4. If organ donation is relevant, contact the hospital's organ procurement coordinator — they are typically involved within hours of a death where donation may be possible.

For most estate settlement purposes, you will not need to directly access the End of Life Registry yourself. Its function is primarily in the medical context before or at the time of death, not in the administrative process that follows.

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