State of Missouri to Create an Advance Health Care Directives Registry

November 2017

Missouri has enacted a new law establishing the Advance Health Care Directives Registry, intended to safely store advance health care directives online for direct access by authorized health care providers. The law instructs the Missouri Department of Health and Senior Services to contract with a third-party developer to design and build the registry. When the registry is complete, documents may be submitted electronically by licensed health care providers or licensed attorneys. All documents will be confidential and exempt from Missouri Sunshine Laws.

What Is an Advance Health Care Directive, and Why Do You Need One?

Under Missouri law, an advance health care directive is defined as a power of attorney for health care or a declaration signed by an adult containing his or her wishes regarding health care decisions. A power of attorney for health care allows you to appoint another person to make your health care decisions in the event that you become physically or mentally unable to communicate your wishes for medical care. A health care directive can be used to provide the clear and convincing evidence required under Missouri law as to whether you would wish to receive life-sustaining medical treatment.

In the absence of an advance health care directive, some states allow health care providers to follow the instructions of family members whom the law grants precedence. For example, instructions given by a spouse might be treated by the law as taking precedence over those that might have been given by adult children, parents, or siblings. However, this procedure is not the established law of Missouri. Without a valid durable power of attorney for health care and health care declaration, a court order might be necessary to appoint an individual to make decisions related to your health care and life-sustaining treatment. This court intervention and the associated expense, delay, and effort can be avoided by your having executed a health care directive and durable power of attorney. Once the registry is implemented, having your health care declaration and durable power of attorney for health care uploaded to the registry will allow your loved ones to act quickly and to alleviate the undue burden on them during an already difficult time.

What Does This Mean for Health Care Providers?

Just as it is important for patients to execute an advance health care directive, physicians, hospitals, and other health care providers could also benefit from the existence of the registry. Absent an advance directive, doctors, nurses, and hospital staff can become entangled in family disputes or left waiting for a court to appoint a guardian to decide important and possibly life-or-death medical decisions. Putting the Advance Health Care Directives Registry to use could help avoid these problems and ease the process of caring for patients who are or become incapacitated.

Health care providers should encourage patients to consider their wishes regarding health care decisions, consult with a knowledgeable attorney, and execute advance health care directives accordingly. Furthermore, since licensed health care providers are authorized to submit documents into the registry, they should implement policies to obtain these documents and upload them.  Finally, health care providers should train staff to check the registry promptly whenever a patient is or becomes incapacitated. In these ways, hospitals and other health care providers in Missouri will be in a position to take advantage of the Advance Health Care Directives Registry when it becomes available.

Please contact a Lewis Rice estate planning or health law attorney if you have any questions about this new development.