Health Care Directives in Connecticut

Health Care Directives in Connecticut

A Connecticut health care directive is a legal document that records your wishes about medical treatment and names a person to make health care decisions for you if you cannot make them yourself. The primary statutory form combines both functions into a single document under CGS 19a-575a.

Two Components, One Document

Connecticut law provides for two distinct advance directive components:

Living will (health care instructions). Under CGS 19a-575, this is a written statement directing that life support systems be withheld or withdrawn if your condition is terminal or you are permanently unconscious. The statutory form specifically addresses artificial respiration, cardiopulmonary resuscitation, and artificial nutrition and hydration.

Appointment of a health care representative. Under CGS 19a-575a, this designates a specific person to make health care decisions on your behalf when you cannot.

While you can execute a standalone living will under CGS 19a-575, the combined form under CGS 19a-575a is far more common in practice. The combined form also includes provisions for designating a conservator of the person and making an anatomical gift.

Terminology: “Health Care Representative,” Not “Health Care Agent”

Connecticut changed its terminology effective October 1, 2006. The person you appoint is called your health care representative, not your “health care agent.” Documents and websites that use the term “health care agent” are either outdated or referring to another state’s law.

New York, by contrast, uses the term “health care proxy” for both the document and the appointed person. If you see “health care proxy” on a form, that is a New York document. Connecticut’s equivalent is the health care representative appointment under CGS 19a-575a.

Execution Requirements

To be valid, a Connecticut health care directive must be:

1. Signed and dated by the maker. The person executing the document must be at least 18 years old, of sound mind, and able to understand the nature and consequences of health care decisions.
2. Witnessed by at least two people. Both witnesses must sign in the maker’s presence and at the maker’s request. The witnesses should confirm that the maker appeared to be of sound mind and under no improper influence.

The statutory form in CGS 19a-575a also includes an optional sworn affidavit section, where the witnesses attest under oath before a notary public or commissioner of the Superior Court. Including the affidavit is not required for validity, but it strengthens the document and parallels the self-proving affidavit concept used for wills.

There is no requirement that the health care representative sign the document at the time of execution, though some practitioners obtain the representative’s acknowledgment as a practical matter.

Authority of the Health Care Representative

The health care representative’s authority activates when your attending physician or advanced practice registered nurse (APRN) determines that you are unable to understand and appreciate the nature and consequences of health care decisions and unable to reach and communicate an informed decision regarding treatment.

Once activated, the representative may:

• Accept or refuse any treatment, service, or procedure used to diagnose or treat a physical or mental condition
• Provide, withhold, or withdraw life support systems
• Make decisions consistent with the maker’s wishes as stated in the directive or as otherwise known to the representative

Two categories of treatment are excluded: psychosurgery and shock therapy as defined in CGS 17a-540. The representative cannot consent to these.

If the maker’s wishes are not clear or a situation arises that the directive does not address, the representative may make a decision in the maker’s best interests, based on what is known of the maker’s values and preferences.

APRN Provisions

Connecticut’s 2018 amendments expanded the role of advanced practice registered nurses throughout the health care directive statutes. APRNs may now serve in the same capacity as physicians for purposes of determining a patient’s incapacity and carrying out directive provisions. The statutory forms reference “physician or advanced practice registered nurse” throughout.

Pregnancy Provisions

The statutory forms include three options if the maker is pregnant at the time life support decisions must be made:

1. Accept life support if the doctor believes it would allow the fetus to reach a live birth
2. Apply the directive without modification
3. Specify alternative instructions

If the maker does not select any option, the directive may still apply, but ambiguity could lead to disputes. Selecting an option at the time of execution avoids this problem.

Revocation

Revoking the living will portion is straightforward: the maker can revoke it at any time, by any means that communicates the intent to revoke.

Revoking the health care representative appointment is more formal. Under CGS 19a-575a(b), the revocation must be in writing, signed by the maker, and witnessed by two people. This higher standard exists because the representative appointment delegates authority to another person, and the law wants clear evidence that the maker truly intended to revoke it.

Revoking the representative appointment does not automatically revoke the living will (CGS 19a-575a(e)). They are treated as independent components even when contained in the same document.

Transition Rules for Pre-2006 Documents

Connecticut overhauled its advance directive law effective October 1, 2006. CGS 19a-580f provides that documents properly executed before that date remain valid:

• Pre-2006 advance directives retain full legal force
• Pre-2006 health care agent appointments (the former terminology) retain legal force as if executed under the law at the time
• Pre-2006 powers of attorney for health care decisions retain effect under the former CGS 1-54a

You do not need to re-execute a pre-2006 directive for it to be honored. However, updating to the current form is advisable. Health care providers are more familiar with the current statutory language, and the updated form addresses situations (such as APRN authority and pregnancy options) that the older forms did not contemplate.

Dispute Resolution

The Probate Court has jurisdiction over disputes concerning health care directives (CGS 19a-580c). This includes disputes about the meaning of the directive, the capacity of the health care representative, and claims that the representative’s actions would interfere with treatment. Oral communications of a patient’s wishes (as opposed to written directives) must be proved by clear and convincing evidence.

A person whose appointment as health care representative has been revoked has standing to challenge the validity of the revocation in Probate Court.

How Connecticut Compares to New York

New York uses a “health care proxy” form under NY Public Health Law Article 29-C. Key differences:

If you split time between Connecticut and New York, or receive medical care in both states, executing directives that comply with both states’ requirements is strongly recommended. A Connecticut directive may not be immediately recognized by a New York hospital, and vice versa.

Practical Recommendations

Give copies to your health care representative, your alternative representative, your primary care physician, and any hospital where you regularly receive care. Keep the original in a location your representative can access quickly; a safe deposit box that only you can open is the wrong place.

Discuss your wishes with your representative before a crisis. The legal document provides authority, but the conversation provides guidance. Your representative will make better decisions if they understand your values, your tolerance for certain treatments, and the conditions under which you would or would not want aggressive intervention.

Review your directive after any significant health event, change in family circumstances, or change in your relationship with your representative.

For the related document that covers financial decision-making, see Connecticut powers of attorney. For a comparison of how Connecticut and New York handle health care directives differently, see NY-CT cross-border estate planning.

If a health care directive is not in place and the person has lost capacity, the Probate Court may need to appoint a conservator of the person to make medical decisions. Establishing a health care directive while you have capacity avoids this more costly and time-consuming process.