Ohio: Living Will and Advance Health-Care Instruction Requirements

Ohio calls its treatment instruction a declaration. It comes from the Modified
Uniform Rights of the Terminally Ill Act, R.C. §§ 2133.01 to 2133.15, and it is a
separate document from the durable power of attorney for health care that names an
agent and from DNR identification that directs resuscitation care.

Requirements one by one

Governing law and document

The act defines a declaration narrowly. Section 2133.01(F) says it "means a written
document executed in accordance with section 2133.02 of the Revised Code." That single
sentence rules out the oral and nonverbal routes some states allow.

Ohio also fixes what happens when two of your documents disagree. Under
§ 2133.03(B)(2), if you have both a valid health-care power of attorney and a valid
declaration, "the declaration supersedes the durable power of attorney for health care"
to the extent they conflict once you are in a terminal condition or permanently
unconscious state. A declaration also overrides a conflicting general consent-to-
treatment form you signed at admission, even one signed later (§ 2133.03(B)(1)(a)).

Who may make an instruction

Section 2133.02(A)(1) opens the door to "[a]n adult who is of sound mind," acting
voluntarily, at any time. "Adult" means 18 or older (§ 2133.01(A)).

Ohio separates two words that sound alike. A declarant is anyone who has executed a
declaration. A qualified patient is a declarant who has since been determined to be
in a terminal condition or a permanently unconscious state (§ 2133.01(Z)). You are a
declarant the day you sign; you become a qualified patient only if the medical findings
are later made.

Oral, written, and signature form

The declaration must be signed at the end, either by you or "by another individual at
the direction of the declarant," and must state the date of execution (§ 2133.02(A)(1)).

Section 2133.02(A)(2) adds a drafting rule that is easy to miss. Your declaration must
actually use the term "terminal condition," "permanently unconscious state," or both,
depending on which you intend to cover, and must define or explain those terms in
capital letters in a way substantially consistent with § 2133.01. A declaration that
gestures at "hopeless illness" without using and defining the statutory term is not
following the section.

Witness, notary, and disqualifications

Section 2133.02(B) gives a true either/or. You may use two witnesses in whose presence
you or your directed signer signed, or you may acknowledge the declaration before a
notary public. The notary route is a full alternative, not an addition.

Witnesses must be adults and must not be:

• related to you by blood, marriage, or adoption;
• your attending physician; or
• the administrator of any nursing home where you are receiving care.

Each witness signs after your signature and by doing so attests to a belief that you
appear to be of sound mind and not under duress, fraud, or undue influence. The statute
expressly says the signatures "are not required to appear on the same page."

Covered conditions and trigger

Signing does not make the declaration operate. Section 2133.03(A)(1) requires four
things at once: the declaration has been communicated to your attending physician; that
physician and one other physician who examines you determine you are in a terminal
condition or a permanently unconscious state, whichever your declaration addresses; the
requirements of divisions (A)(2) and (3) are met; and the attending physician determines
you can no longer make informed decisions about life-sustaining treatment.

The two conditions have precise statutory tests. A terminal condition is
"irreversible, incurable, and untreatable," with no recovery possible and death "likely
to occur within a relatively short time if life-sustaining treatment is not
administered" (§ 2133.01(AA)). A permanently unconscious state requires both
irreversible unawareness of one's being and environment and total loss of cerebral
cortical functioning leaving no capacity to experience pain or suffering
(§ 2133.01(U)).

For permanent unconsciousness, § 2133.03(A)(2) adds a qualification requirement: the
second physician must be qualified by advanced education, training, limited practice,
specialty certification, or experience to make that determination. Any licensed
physician will not do.

Treatment, nutrition, hydration, and comfort choices

A declaration governs "the use or continuation, or the withholding or withdrawal, of
life-sustaining treatment" — meaning any measure that "will serve principally to prolong
the process of dying" (§§ 2133.02(A)(1), 2133.01(Q)). You may specifically address CPR,
and § 2133.02(A)(1) says that failing to mention CPR does not by itself prevent its
withdrawal under the act.

Artificial nutrition and hydration are handled separately, and the extra step is
described under "What trips people up" below.

Comfort care is the floor. Section 2133.01(C) defines it to include nutrition and
hydration administered to diminish pain or discomfort rather than to postpone death, and
§ 2133.12(E)(1) preserves the attending physician's responsibility to provide it. The
same division protects a physician who prescribes or administers medication "by judicious
titration or in another manner" to diminish pain, "even though the medical procedure,
treatment, intervention, or other measure may appear to hasten or increase the risk of
the patient's death."

Pregnancy and other statutory limits

Section 2133.06(B) states one express pregnancy rule, and it binds provider action under
a declaration. Life-sustaining treatment "shall not be withheld or withdrawn from a
declarant pursuant to a declaration if she is pregnant and if the withholding or
withdrawal of the treatment would terminate the pregnancy," with a single exception: the
attending physician and one other examining physician determine, to a reasonable degree
of medical certainty and in accordance with reasonable medical standards, that "the fetus
would not be born alive." The statute sets no gestational-age or viability threshold.

Two other limits bound the document's legal effect. Section 2133.12(D) says nothing in
the act "condones, authorizes, or approves of mercy killing, assisted suicide, or
euthanasia." Section 2133.12(A) says a death resulting from withholding or withdrawal in
accordance with the act is not a suicide or any homicide offense for any purpose.

Section 2133.12(B)(4) also bars any physician, facility, insurer, or health plan from
requiring you to execute, revoke, or refrain from either as a condition of coverage or
care.

Revocation, notice, and registry

Section 2133.04(A) is unusually broad: you may revoke "at any time and in any manner."
The statute sets no capacity requirement for revoking and names no required method.

Timing is the part that matters. Revocation is effective "when the declarant expresses an
intention to revoke," except that if you had made your attending physician aware of
the declaration, it becomes effective only when communicated to that physician — by you,
by a witness to the revocation, or by other health-care personnel whom that witness told.
The physician must then make the revocation part of your medical record (§ 2133.04(B)).

Ohio has no state living-will registry.

Provider duties, recognition, and effect

Once the declaration is operative, the attending physician and health-care facilities
"shall act in accordance with its provisions or comply with the provisions of section
2133.10" (§ 2133.03(A)(1)).

Refusal is permitted but structured. Under § 2133.02(D)(1) a physician or facility may
decline "on the basis of a matter of conscience or on another basis," while an employee
or agent may decline only on conscience grounds. A declining physician or facility must
"promptly so advise the declarant" and then follow § 2133.10, which bars preventing or
unreasonably delaying transfer to a willing provider. Where your declaration directs that
treatment be used or continued, § 2133.10(B) requires the unwilling provider to keep
providing it until the transfer happens.

Out-of-state documents travel well. Section 2133.14 validates a declaration executed
under another state's law "in compliance with that law or in substantial compliance with"
Ohio's act.

What trips people up

Nutrition and hydration need their own conspicuous statement plus your initials.
This is the single most common defect in an Ohio declaration. Under § 2133.02(A)(3)(a),
if you want your attending physician to be able to withhold or withdraw nutrition or
hydration while you are in a permanently unconscious state, checking the general
life-sustaining-treatment box is not enough. You must do both of the following in the
declaration: include a statement in capital letters or other conspicuous type (a
different font, bigger type, or boldface) saying the physician may withhold or withdraw
nutrition and hydration in that state if the two-physician comfort determination is made,
or check a box adjacent to a similar statement on a printed form; and place your
initials or signature underneath or next to that statement, check, or mark.

Division (A)(3)(b) limits the rule: it does not apply to the extent your declaration
covers a terminal condition. The extra step is specific to permanent unconsciousness.

The twelve-month clock is not part of your declaration. Ohio's twelve-month
permanently-unconscious waiting period, and the probate-court order that goes with it,
appear in §§ 2133.08 and 2133.09, which govern consent by family members for a patient
who has no declaration. When you have signed a declaration that clears
§ 2133.02(A)(3)(a), the physician acts under §§ 2133.03 and 2133.05 instead. Signing is
what avoids that route.

Your current wishes outrank the paper. Section 2133.06(A) preserves a qualified
patient's ability to keep making decisions "[a]s long as" the patient can make informed
ones. The declaration speaks only after the incapacity finding.

Telling your doctor changes how you must revoke. Because § 2133.04(A) makes
revocation effective on communication to the attending physician once that physician knew
about the declaration, tearing the document up at home does not revoke it as to a
physician who has a copy in your chart until word reaches them.

The notification list has a fixed priority order. If your declaration does not name
anyone to be notified, § 2133.05(A)(2)(a)(ii) supplies a descending order: guardian, then
spouse, then available adult children, then parents, then an adult sibling or a majority
of available adult siblings. Naming your own person in the declaration displaces that
list.

Common questions

Do I need a lawyer, or can I use a printed form?
Section 2133.07(B) expressly allows printed declaration forms to be sold or distributed
"for use by adults who are not advised by an attorney." A printed form may not grant any
other kind of authority, with two exceptions: you may specify on it that you want it to
serve as DNR identification, and § 2133.07(C) requires the form to carry an optional
anatomical-gift section. If you leave that section blank, the statute says "no
presumption is created about my desire to make or refuse to make an anatomical gift."

Does a declaration affect my life insurance?
No. Section 2133.12(B)(1) says executing a declaration does not affect the sale,
issuance, or renewal of a life insurance policy or annuity, notwithstanding any policy
term to the contrary, and (B)(2) says a withholding or withdrawal in accordance with the
act does not impair or invalidate the policy.

What if I never sign one — does that mean I want everything done?
No. Section 2133.12(C)(1) says the act creates no presumption about the intention of a
person who has revoked or never executed a declaration. Without one, decisions for an
adult in a terminal condition or permanently unconscious state run through the separate
consent process in § 2133.08.

Can a doctor be sued for following a declaration that turns out to be defective?
Section 2133.13 lets an attending or consulting physician, other health-care personnel,
and facilities assume a declaration complies with the act and is valid, absent actual
knowledge to the contrary and if acting in good faith.

Statutes and sources

• Ohio Rev. Code § 2133.01 (definitions: adult, comfort care, declaration, hydration,
  life-sustaining treatment, nutrition, permanently unconscious state, qualified patient,
  terminal condition). Current text as amended by 122nd G.A. Sub. H.B. 354.
  Enrolled act
  — accessed 2026-08-01.
• Ohio Rev. Code § 2133.02 (execution, capital-letter term rule, nutrition-and-
  hydration statement and initials, witnesses, notary, medical record, provider refusal).
  Current text as amended by 123rd G.A. Am. Sub. H.B. 494.
  Enrolled act
  — accessed 2026-08-01.
• Ohio Rev. Code § 2133.03 (when a declaration becomes operative; consulting-physician
  qualification; supersedes consent form and health-care power of attorney). Current text
  as amended by 122nd G.A. Sub. H.B. 354.
  Enrolled act
  — accessed 2026-08-01.
• Ohio Rev. Code § 2133.04 (revocation at any time and in any manner; effectiveness on
  communication; medical-record notation). Current text as amended by 129th G.A. Am. Sub.
  S.B. 124.
  Enrolled act
  — accessed 2026-08-01.
• Ohio Rev. Code § 2133.05 (attending-physician duties; notification priority order).
  Current text as amended by 131st G.A. Sub. H.B. 451.
  Enrolled act
  — accessed 2026-08-01.
• Ohio Rev. Code § 2133.06 (qualified patient's continuing decisions; pregnancy
  limit). Current text as amended by 129th G.A. Am. Sub. S.B. 124.
  Enrolled act
  — accessed 2026-08-01.
• Ohio Rev. Code § 2133.07 (printed forms; DNR use; mandatory optional anatomical-gift
  statement). Current text as amended by 134th G.A. H.B. 7, which also repealed
  § 2133.16 and moved its anatomical-gift form into this section.
  Enrolled act
  — accessed 2026-08-01.
• Ohio Rev. Code § 2133.10 (provider unwilling or unable; no prevention or unreasonable
  delay of transfer; continued treatment pending transfer). Current text as amended by
  122nd G.A. Sub. H.B. 354.
  Enrolled act
  — accessed 2026-08-01.
• Ohio Rev. Code § 2133.12 (not suicide or homicide; insurance protections; no
  presumption from not executing; no mercy killing or assisted suicide; comfort-care
  responsibility). Current text as amended by 131st G.A. Sub. H.B. 451.
  Enrolled act
  — accessed 2026-08-01.
• Ohio Rev. Code §§ 2133.13 and 2133.14 (good-faith reliance; out-of-state
  declarations). Current text as amended by 122nd G.A. Sub. H.B. 354.
  Enrolled act
  — accessed 2026-08-01.