Montana POLST Form, Living Will, and Advance Directive: Which One You Need

When you're planning for a medical crisis or the end of life in Montana, three different documents can express your healthcare wishes: a POLST form, a living will, and an advance healthcare directive. They serve different purposes, apply in different situations, and require different steps to make them effective.

Understanding which one you need — and making sure the right people can actually access it in an emergency — is the practical challenge most families face.

The Montana POLST Form

POLST stands for Provider Orders for Life-Sustaining Treatment. In Montana, this is a physician's order, not simply a personal declaration.

The POLST form is a standardized medical document completed by a physician and the patient together. It translates the patient's wishes into immediate, legally binding medical orders that emergency responders and healthcare providers can act on without additional physician authorization. A living will or advance directive often requires interpretation; a POLST does not.

The form addresses specific interventions:

• Cardiopulmonary resuscitation (CPR) — attempt or do not attempt
• Medical interventions — full treatment, selective treatment, or comfort-focused care only
• Artificial nutrition — long-term artificial nutrition, a defined trial period, or no artificial nutrition

A Montana POLST must be signed by a physician (or in some cases, a nurse practitioner or physician assistant) to be a valid medical order. It cannot be created by the patient alone.

Who needs a POLST: People with serious illness, advanced frailty, or who are approaching end of life within the next year or two. It is not a general estate planning document — it is a clinical tool for people who are already medically fragile.

The Montana Living Will (Terminal Conditions Declaration)

Montana's living will statute allows individuals to formally declare their preferences regarding life-sustaining treatment if they become permanently unconscious or have a terminal condition from which no recovery is expected.

Unlike a POLST, a living will is not a physician's order. It is a declaration of personal intent that healthcare providers are required to honor. It activates when the person can no longer communicate their own decisions.

Montana law recognizes the "Five Wishes" document as a living will format, provided it is signed and witnessed by two people. The Five Wishes document covers:

• Which person should make healthcare decisions when you cannot
• What kind of medical treatment you want or don't want
• Comfort and pain management preferences
• How you want people to treat you
• What you want your loved ones to know

A standard Montana living will must be signed and witnessed by two individuals who are not healthcare providers directly involved in your care, not related to you by blood or marriage, and not entitled to benefit financially from your death.

The Montana Advance Healthcare Directive

An advance healthcare directive is the broadest of the three documents. It typically includes both a living will section (your treatment preferences) and a healthcare power of attorney (the designation of an agent to make decisions on your behalf).

The healthcare power of attorney component activates whenever you are unable to make medical decisions yourself — not only at the end of life, but also for temporary incapacitation from surgery, an accident, or illness.

Montana's advance healthcare directive gives your designated agent legal authority to communicate with physicians, consent to or refuse treatments, and make decisions consistent with your expressed wishes. Without this document, doctors will turn to your family members in the order established by state law — which may not align with who you'd actually choose.

The Montana End-of-Life Registry: Why Your Document Is Only as Good as Its Accessibility

Completing any of these documents is meaningless if emergency responders cannot access them when it matters.

Montana's Department of Justice, through the Office of Consumer Protection, operates the Montana End-of-Life Registry — a free, electronic database that stores advance directives and allows healthcare providers to retrieve them 24 hours a day. You do not need an attorney to register, and there is no fee.

When you register, you receive:

• An access code
• A wallet card with your access code printed on it

Montana offers two privacy tiers:

• Standard Privacy: The document can be viewed by healthcare providers and by anyone who provides your Social Security number, date of birth, and mother's maiden name.
• Higher Privacy: The document can only be viewed by healthcare providers and individuals who have your specific access code from the wallet card.

Most people who want extra security choose Higher Privacy and give their healthcare agent a copy of the wallet card.

To register, visit dojmt.gov/consumer/end-of-life-registry/ and follow the Consumer Registration Agreement process.

Which Document You Actually Need

The right combination depends on your situation:

If you are healthy and planning ahead: An advance healthcare directive (including both a living will and healthcare power of attorney) is the right starting point. Register it with the Montana End-of-Life Registry so it is accessible in an emergency.

If you have a serious illness or are entering a nursing home or hospice: Talk to your physician about completing a POLST form in addition to your advance directive. The POLST gives emergency responders and care facility staff immediate, actionable orders they can act on without consulting additional documentation.

If you are an adult of any age: Even if you're in good health, designating a healthcare power of attorney is important. Unexpected incapacitation from an accident or surgery happens at any age, and having a named decision-maker avoids confusion and family conflict.

You can have all three documents. They are not mutually exclusive — they work at different layers of the healthcare decision-making process.

What Happens If You Have None of These Documents

If you have no advance directive, living will, or POLST form, and you become unable to make healthcare decisions, Montana law requires medical providers to consult family members in a specific order:

1. Your spouse or domestic partner
2. Your adult children
3. Your parents
4. Your siblings
5. More distant relatives

If family members disagree about your care, the dispute must often be resolved through the courts. This is avoidable with simple paperwork completed in advance.

Keeping Your Documents Current

Montana law allows you to revoke or update any advance directive at any time while you have capacity. If your healthcare agent is a former spouse, an estranged family member, or someone who has predeceased you, update your documents immediately.

Notify your physician, hospital, and healthcare agent when you update your directives. Re-register the updated version with the Montana End-of-Life Registry — the registry allows document updates, and the old version can be removed from public access.

Advance directives protect your healthcare wishes. The estate side — probate, small estate affidavits, TOD deeds, Medicaid recovery — is a different but equally important piece. The Montana Funeral Laws & Consumer Rights Guide covers both: what to prepare before death and the exact steps families take after it.

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