Rhode Island: Living Will and Advance Health-Care Instruction Requirements
The short answer
Rhode Island's Rights of the Terminally Ill Act lets a competent person age 18 or older execute a signed declaration personally or through a directed signer in the presence of two subscribing witnesses who are not related by blood or marriage; the Act does not offer notarization as an alternative. The declaration operates only after it reaches the attending physician, that physician determines a terminal condition, and the person is unable to make treatment decisions. The optional form directs withholding or withdrawal of procedures that merely prolong dying, preserves comfort and pain care, and requires a separate choice about artificial feeding; a probable-live-birth pregnancy rule suspends the declaration.
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This is the general rule in Rhode Island. Ezel applies current Rhode Island law to your specific facts and answers with citations to the statutes.
| 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) |
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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.
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