Health Care Power of Attorney Requirements in Kentucky

At a glance

Kentucky does not have a standalone "health care power of attorney." Instead it folds the appointment of a medical decision-maker into a single document called a living will directive (the statute also calls it an advance directive). One part of that directive records your treatment wishes; another part lets you designate a health care surrogate — the person who makes medical decisions for you if you lose the ability to make them yourself. This page is about executing that surrogate designation. The rules live in the Kentucky Living Will Directive Act, KRS 311.621 to 311.643.

Requirements one by one

Governing law and document

There is one instrument. Under KRS 311.623(1), an adult with decisional capacity may make a written living will directive that addresses end-of-life treatment, artificial nutrition and hydration, and the designation of one or more adult surrogates or successor surrogates to make health care decisions. So the surrogate appointment are two parts of the same directive. Kentucky publishes an optional statutory form at KRS 311.625(1), but the form is not mandatory — the statute says a directive need only be "substantially in the following form," and other written directives are expressly allowed.

Who can sign

The signer must be an adult — defined at KRS 311.621(1) as "a person eighteen (18) years of age or older and who is of sound mind" — who has decisional capacity, meaning "the ability to make and communicate a health care decision." Under KRS 311.625(2) the directive must be "in writing, dated, and signed by the grantor, or at the grantor's direction." That last phrase lets someone who cannot physically sign have another person sign for them, at their direction.

Witnesses or notary

This is the step people most often get wrong. KRS 311.625(2) gives you a choice: the directive must either be witnessed by two or more adults in the grantor's presence and in each other's presence, or be acknowledged before a notary public or another person authorized to administer oaths. You do not need both. Two qualified witnesses and a notary are interchangeable ways to validate the document. If you use witnesses, they must sign in your presence and in each other's presence.

Who can't witness or serve

KRS 311.625(2) bars five categories from acting as a witness or as the notary: "(a) A blood relative of the grantor; (b) A beneficiary of the grantor under descent and distribution statutes of the Commonwealth; (c) An employee of a health care facility in which the grantor is a patient, unless the employee serves as a notary public; (d) An attending physician of the grantor; or (e) Any person directly financially responsible for the grantor's health care." Note the narrow carve-out: a facility employee may act as your notary, but not as a witness.

A separate limit governs who may serve as surrogate. Under KRS 311.625(4), an "employee, owner, director, or officer of a health care facility where the grantor is a resident or patient shall not be designated or act as surrogate unless related to the grantor within the fourth degree of consanguinity or affinity or a member of the same religious or fraternal order." And under KRS 209.115, anyone "convicted of a felony" under Kentucky's adult-protection chapter is disqualified from serving as "health care surrogate as to the victim of the offense."

When the surrogate can act

The surrogate's authority is springing — it never operates while you can still decide for yourself. KRS 311.629(2) provides that the surrogate "may not make a health care decision in any situation in which the grantor's attending physician has determined in good faith that the grantor has decisional capacity." So the attending physician's determination that you have lost decisional capacity is what switches the surrogate's authority on. Kentucky's statute gives no option to make the surrogate effective immediately while you still have capacity. If a court later appoints a guardian or other fiduciary over you, that does not override your directive: KRS 311.6231 makes the fiduciary "bound by the terms of the grantor's advance directive," and your surrogate "may continue to act."

Surrogate's powers and limits

Once the authority is in effect, KRS 311.629(1) lets the surrogate "make health care decisions for the grantor which the grantor could make individually if he or she had decisional capacity," but "all the decisions shall be made in accordance with the desires of the grantor as indicated in the advance directive." Unlike some states, Kentucky's statute does not enumerate a list of decisions no agent may ever make (such as commitment, psychosurgery, or sterilization); the main statutory limits are two. First, withdrawing artificial nutrition and hydration is allowed only in the four situations listed in KRS 311.629(3) (imminent death, permanent unconsciousness with an authorizing directive, inability to assimilate it, or burden outweighing benefit), and never when needed for comfort or pain relief. Second, KRS 311.629(4) requires that a pregnant grantor receive life-sustaining treatment and ANH unless the attending physician and one other physician certify that the treatment will not permit a live birth, will physically harm the woman, or will prolong severe pain.

How to revoke

KRS 311.627(1) gives you three ways to revoke: "(a) A writing declaring an intention to revoke, which writing shall be signed and dated by the grantor; (b) An oral statement of intent to revoke made by a grantor with decisional capacity in the presence of two (2) adults, one (1) of whom shall be a health care provider; or (c) Destruction of the document." An oral revocation "shall override any previous written advance directive," and making a new surrogate designation revokes the earlier one. Kentucky's Act has no provision automatically revoking a spouse-surrogate on divorce — a gap worth knowing.

Out-of-state directives

Kentucky's Act has no express provision saying a directive validly executed in another state is honored here. What it does say, in KRS 311.637(6), is that the Act "shall not restrict or preclude medical personnel, physicians, nurses, or health care facilities from following other written advance directives consistent with accepted medical practice," and the definition of "advance directive" in KRS 311.621(1) is broad enough to include "any other document that provides directions relative to health care." A directive from another state may therefore be honored, but Kentucky does not guarantee it the way states with a formal reciprocity clause do.

What trips people up

• You do not need a notary if you have two witnesses. People often assume a medical directive must be notarized. In Kentucky it is one option, not a requirement — two qualified adult witnesses do the same job (KRS 311.625(2)).
• A relative or heir cannot witness or notarize. Blood relatives, anyone who would inherit from you, your attending physician, and anyone paying for your care are all disqualified (KRS 311.625(2)). A common mistake is having an adult child sign as a witness; that invalidates the witness path.
• Divorce does not cancel a spouse-surrogate. Unlike many states, Kentucky has no statute revoking your spouse's authority when you divorce. If you named your spouse and later divorce, you must sign a new directive (or revoke under KRS 311.627) to remove them.
• The surrogate cannot act while you still can. Even after you sign, the surrogate has no authority until your attending physician determines you lack decisional capacity (KRS 311.629(2)).

Common questions

Does a Kentucky living will directive have to be notarized? No. You can either have it notarized or have two qualified adult witnesses sign it in your presence and each other's — your choice (KRS 311.625(2)).

Can I name someone to make decisions now, before I lose capacity? Kentucky's surrogate authority is springing by law. The surrogate can act only after your attending physician determines you lack decisional capacity (KRS 311.629(2)); there is no box to make it effective immediately.

Can my surrogate stop a feeding tube? Only in narrow circumstances. Withdrawing artificial nutrition and hydration is limited to the four situations in KRS 311.629(3), and never when it is needed for comfort or to relieve pain.

Will the directive I signed in another state work in Kentucky? Possibly. Kentucky has no reciprocity clause, but providers are not barred from following other written directives consistent with accepted medical practice (KRS 311.637(6)). To be safe, sign a Kentucky directive if you live or expect care here.

Statutes and sources

• KRS 311.623(1) — an adult with decisional capacity may make a written living will directive designating a surrogate. https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=44036 (accessed 2026-08-20)
• KRS 311.621(1) — definitions of "adult," "decisional capacity," and "advance directive." https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=44034 (accessed 2026-08-20)
• KRS 311.625 — form of the directive; execution requirement (dated, signed, and either two adult witnesses or a notary), the five disqualified witnesses/ notaries, and the bar on a facility employee serving as surrogate. https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=42591 (accessed 2026-08-20)
• KRS 209.115 — a person convicted of a felony under the adult-protection chapter cannot serve as health care surrogate for the victim. https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=39694 (accessed 2026-08-20)
• KRS 311.629 — powers of the health care surrogate; springing effect; limits on withdrawing artificial nutrition and hydration; pregnancy rule. https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=30567 (accessed 2026-08-20)
• KRS 311.6231 — a later court-appointed fiduciary is bound by the directive; the surrogate may continue to act. https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=30561 (accessed 2026-08-20)
• KRS 311.627 — revocation by signed writing, oral statement before two adults (one a provider), or destruction. https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=30565 (accessed 2026-08-20)
• KRS 311.637(6) — the Act does not preclude providers from following other written advance directives. https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=44038 (accessed 2026-08-20)