Living Will and Advance Health-Care Instruction Requirements in Rhode Island
At a glance
| Governing law and document | Rhode Island Rights of the Terminally Ill Act, R.I. Gen. Laws ch. 23-4.11. Survey covers § 23-4.11-3 witnessed treatment 'declaration' and optional form; distinct from ch. 23-4.10 durable health-care POA and § 23-4.11-3.1 MOLST clinician order |
|---|---|
| Who may make an instruction | Competent individual age 18+ may execute anytime (§ 23-4.11-3(a)). Statutory form recites sound mind, willfulness, and voluntariness. No Rhode Island-residency requirement appears in living-will chapter (contrast health-care-POA form) |
| Oral, written, and signature form | Witnessed written document signed by declarant or another at declarant's direction in presence of 2 subscribing witnesses (§§ 23-4.11-2(4), -3(a)). Optional form includes date/address, but operative execution rule states no date requirement. No oral creation or electronic-specific execution route |
| Witness, notary, and disqualifications | 2 subscribing witnesses required; both must be unrelated to declarant by blood or marriage (§ 23-4.11-3(a)). Chapter states no minimum witness age, provider/facility/employee bar, inheritance bar, or notary alternative. Do not import broader witness/notary rules from health-care-POA chapter |
| Covered conditions and trigger | Operative only when communicated to attending physician, physician determines terminal condition, and declarant cannot make treatment decisions (§ 23-4.11-3(c)). Terminal means incurable/irreversible condition that without life-sustaining procedures will result in death; procedure then only prolongs dying (§ 23-4.11-2). One attending physician; no PVS/end-stage route |
| Treatment, nutrition, hydration, and comfort | Optional form directs withholding/withdrawal of procedures that merely prolong dying and are unnecessary for comfort/pain, with separate include/do-not-include checkbox for artificial feeding (§ 23-4.11-3(d)). Artificial feeding means non-voluntary-oral nutrition/hydration (§ 23-4.11-2(2)); comfort/care/pain actions remain allowed (§ 23-4.11-6(b)) |
| Pregnancy and other statutory limits | Declaration has no force while attending physician knows patient is pregnant and continued life-sustaining procedures probably permit fetal development to live birth (§ 23-4.11-6(c)). Chapter does not authorize mercy killing/euthanasia; compliant withdrawal is not suicide/homicide (§ 23-4.11-10) |
| Revocation, notice, and registry | Revoke anytime/in any manner communicating intent regardless of mental/physical condition; effective as to physician/provider/EMS when declarant or revocation witness communicates it, and provider records it (§ 23-4.11-4). Later-executed declaration or health-care POA controls inconsistent terms. No directive registry provision in ch. 23-4.11 |
| Provider duties, recognition, and effect | Provider given copy adds it to medical record (§ 23-4.11-3(b)); attending physician records terminal determination/substance (§ 23-4.11-5). Refusing provider arranges transfer to physician who will effectuate declaration (§ 23-4.11-7); statutory immunity/presumed validity (§§ 23-4.11-8, -11). Out-of-state declaration valid if compliant where executed (§ 23-4.11-12) |
Rhode Island uses a standalone declaration under the Rights of the Terminally Ill Act, R.I. Gen. Laws chapter 23-4.11. The declaration covers the adult's own instructions about life-sustaining procedures in a terminal condition. It is distinct from the durable health-care power of attorney in chapter 23-4.10 and the MOLST clinician order in § 23-4.11-3.1.
Requirements one by one
The declaration requires two unrelated witnesses
Under § 23-4.11-3(a), a competent person age 18 or older signs personally or directs another person to sign in the presence of two subscribing witnesses. Both witnesses must be unrelated to the declarant by blood or marriage. The living-will chapter does not make a notary an alternative and does not add the provider, facility, inheritance, or adult-witness bars found in some other Rhode Island documents.
The optional form includes a date, address, and witness blocks, but the operative execution sentence does not separately require a date. The chapter states no oral creation route or electronic-specific execution method.
One physician makes the terminal-condition finding
The declaration operates only after it has been communicated to the attending physician, that physician determines a terminal condition, and the declarant is unable to make treatment decisions (§ 23-4.11-3(c)). A terminal condition is incurable or irreversible and, without life-sustaining procedures, will in the attending physician's opinion result in death (§ 23-4.11-2(20)).
The chapter does not add permanent unconsciousness, persistent vegetative state, or a two-physician certification route. A qualified patient's own current decisions continue to control while the patient can decide (§ 23-4.11-6(a)).
Artificial feeding is a separate choice
The optional form directs the attending physician to withhold or withdraw procedures that merely prolong dying and are not needed for comfort or pain relief. It then requires the declarant to check whether that authorization does or does not include withholding or withdrawal of artificial feeding (§ 23-4.11-3(d)).
Artificial feeding means nutrition or hydration supplied parenterally, nasogastrically, gastrically, or by a method other than voluntary oral sustenance (§ 23-4.11-2(2)). Comfort, care, and pain-relief actions remain permitted under § 23-4.11-6(b).
What trips people up
- The living will and health-care POA have different execution rules. This declaration requires two blood-or-marriage-unrelated witnesses. The separate chapter 23-4.10 power uses its own witness-or-notary form and should not be imported here.
- Pregnancy uses a probable-live-birth test. The declaration has no force while the attending physician knows the qualified patient is pregnant and continued life-sustaining procedures probably would allow the fetus to develop to live birth (§ 23-4.11-6(c)).
- A later inconsistent document controls. If a declaration and durable health-care power conflict, the one executed later controls the inconsistent term (§ 23-4.11-4(a)(3)).
Common questions
May I use a notary instead of two witnesses? No. The living-will rule requires two subscribing witnesses, both unrelated by blood or marriage (§ 23-4.11-3(a)).
Can I revoke after losing capacity? The statute permits revocation at any time and in any manner communicating intent, without regard to mental or physical condition. It becomes effective for the attending physician, provider, or EMS personnel when communicated by the declarant or a person who witnessed the revocation (§ 23-4.11-4).
What if my provider refuses to comply? The attending physician records the terminal determination and declaration's substance under § 23-4.11-5. § 23-4.11-8 supplies the chapter's stated immunities, and § 23-4.11-11 allows providers and EMS personnel to presume validity absent actual contrary notice.
The refusing physician or provider must arrange transfer to another physician who will effectuate the declaration (§ 23-4.11-7).
Will Rhode Island recognize a declaration made elsewhere? Yes. A declaration executed in another state in compliance with that state's law is validly executed for Rhode Island chapter 23-4.11 purposes (§ 23-4.11-12).
Statutes and sources
- R.I. Gen. Laws §§ 23-4.11-2–3 — definitions, execution, operative trigger, optional form, treatment direction, and artificial feeding. Rhode Island General Assembly (accessed 2026-07-31).
- R.I. Gen. Laws §§ 23-4.11-4–8 — revocation, recordkeeping, current patient choice, comfort care, pregnancy, transfer, and immunity. Same official source (accessed 2026-07-31).
- R.I. Gen. Laws §§ 23-4.11-10–12 — legal effect, presumed validity, and out-of-state recognition. Same official source (accessed 2026-07-31).
- R.I. Gen. Laws ch. 23-4.11 index — complete chapter structure and absence of a registry section. Same official source (accessed 2026-07-31).
Source links
Every statute quoted above, linked, with the date we checked it.
What does Rhode Island law mean for your facts?
You just read the general rule. Ask your own question and see which parts of current Rhode Island law apply to your situation, with citations you can check.
Opens in Ezel Pro.
- Starts from the statutes this survey is built on
- Cites every source it relies on, so you can verify it
- Chat, drafting and research in one workspace