KENTUCKY LIVING WILL & ADVANCE HEALTH-CARE DIRECTIVE
(Kentucky Revised Statutes (“KRS”) §§ 311.621 – 311.643)
[// GUIDANCE: This template is drafted to satisfy the Kentucky Living Will Directive Act. Review and adapt bracketed placeholders, optional provisions, and bracketed instructions before execution.]
TABLE OF CONTENTS
- Document Header
- Definitions
- Operative Provisions
3.1 Statement of Intent
3.2 Health-Care Instructions
3.3 Designation of Health-Care Surrogate
3.4 Organ and Tissue Donation (Optional) - Representations & Warranties
- Covenants & Restrictions
- Default & Remedies
- Risk Allocation
- Dispute Resolution
- General Provisions
- Execution Block
1. DOCUMENT HEADER
1.1 Title. This Living Will & Advance Health-Care Directive (this “Directive”) is executed by [PRINCIPAL’S FULL LEGAL NAME] (the “Principal”) on [DATE] pursuant to KRS § 311.625.
1.2 Recitals.
(a) The Principal desires to retain autonomy over end-of-life and other medical decisions in the event the Principal lacks decisional capacity.
(b) The Principal further desires to designate a health-care surrogate and to provide legally binding instructions to health-care providers consistent with Kentucky law.
1.3 Effective Date & Governing Law. This Directive becomes effective upon the Principal’s loss of decisional capacity, as determined under KRS § 311.621(10), and shall be governed exclusively by the laws of the Commonwealth of Kentucky.
2. DEFINITIONS
The following terms, listed alphabetically, shall have the meanings set forth below and apply throughout this Directive:
“Artificial Nutrition and Hydration” means the provision of sustenance via intravenous or nasogastric means.
“Attending Physician” means the physician having primary responsibility for the Principal’s medical care.
“Decisional Capacity” means the ability to make informed health-care decisions, as defined in KRS § 311.621(9).
“Health-Care Surrogate” means the individual designated in Section 3.3 to make health-care decisions on behalf of the Principal when the Principal lacks decisional capacity.
“Life-Prolonging Treatment” means any medical procedure or intervention that serves to prolong the dying process for a person with a Terminal Condition or who is Permanently Unconscious, excluding comfort care.
“Permanently Unconscious” has the meaning set forth in KRS § 311.621(15).
“Terminal Condition” has the meaning set forth in KRS § 311.621(17).
[// GUIDANCE: Add or delete definitions to reflect the Principal’s preferences or evolving statutory language.]
3. OPERATIVE PROVISIONS
3.1 Statement of Intent
The Principal directs that the instructions herein be honored by all health-care providers, facilities, and surrogate decision-makers, and that they prevail over any contrary directives executed prior to the Effective Date.
3.2 Health-Care Instructions
(a) Life-Prolonging Treatment.
(i) Terminal Condition. If the Principal is determined to have a Terminal Condition, the Principal [SELECT ONE: does / does not] want Life-Prolonging Treatment.
(ii) Permanent Unconsciousness. If the Principal is Permanently Unconscious, the Principal [SELECT ONE: does / does not] want Life-Prolonging Treatment.
(b) Artificial Nutrition and Hydration.
The Principal [SELECT ONE: does / does not] want Artificial Nutrition and Hydration if such measures only prolong the dying process.
(c) Pain Management.
The Principal directs that medication be administered to alleviate pain or discomfort even if such medication may hasten death, provided it is consistent with professional medical standards.
(d) Other Instructions. [INSERT any additional treatment preferences, religious considerations, or facility limitations.]
3.3 Designation of Health-Care Surrogate
(a) Primary Surrogate. The Principal designates [SURROGATE NAME], currently residing at [ADDRESS], telephone [PHONE], as Health-Care Surrogate.
(b) Alternate Surrogate(s). If the Primary Surrogate is unable or unwilling to act, the Principal designates in the following order of priority:
(1) [ALTERNATE SURROGATE #1 NAME & CONTACT]
(2) [ALTERNATE SURROGATE #2 NAME & CONTACT]
(c) Scope of Authority. The Surrogate shall have full authority to make any and all health-care decisions the Principal could make if capable, including, without limitation, accessing medical records, consenting to or refusing treatment, and arranging transfer between facilities, subject to the explicit limitations in Section 3.2.
3.4 Organ and Tissue Donation (Optional)
The Principal [SELECT ONE: does / does not] elect to donate organs and tissues pursuant to KRS Chapter 311, Subchapter VI. If elected, the scope of donation is limited to [SPECIFY SCOPE OR “ANY NEEDED”] and is to be performed under the supervision of [ORGAN PROCUREMENT ORGANIZATION].
4. REPRESENTATIONS & WARRANTIES
The Principal represents, warrants, and affirms that:
4.1 Capacity. The Principal is at least eighteen (18) years of age and presently possesses decisional capacity.
4.2 Voluntariness. This Directive is executed voluntarily and without coercion or undue influence.
4.3 Prior Directives. Any prior advance directive or living will executed by the Principal is amended and superseded by this Directive to the extent of any inconsistency.
4.4 Disclosure. The Principal has informed the designated Surrogate(s) of their appointment and provided them with a copy of this Directive.
5. COVENANTS & RESTRICTIONS
5.1 Surrogate Duties. Each Surrogate shall:
(a) Act in good faith, in a manner consistent with the Principal’s known wishes and best interests;
(b) Consult, where feasible, with the Principal’s Attending Physician and immediate family;
(c) Keep records of significant decisions and provide copies to health-care providers upon request.
5.2 Limitation on Surrogate Authority. A Surrogate may not:
(a) Authorize voluntary admission to a mental health facility for more than thirty (30) consecutive days;
(b) Consent to psychosurgery, electroconvulsive treatment, or experimental research except as expressly authorized in Section 3.2(d);
(c) Override a conscious and contemporaneous expression of the Principal’s desires.
5.3 Provider Obligations. Health-care providers shall comply with this Directive in good faith consistent with KRS § 311.627.
6. DEFAULT & REMEDIES
6.1 Failure to Honor Directive. If a provider or institution is unwilling or unable to comply with this Directive, it shall, upon request, facilitate a timely transfer of the Principal to a provider or facility willing to comply.
6.2 Injunctive Relief. The Principal, Surrogate, or interested person may seek injunctive relief to enforce the terms of this Directive.
6.3 Attorney Fees. A prevailing party in litigation to enforce this Directive is entitled to recover reasonable attorney fees and costs.
7. RISK ALLOCATION
7.1 Indemnification of Providers. The Principal agrees to indemnify and hold harmless any health-care provider who acts in good-faith reliance on this Directive, to the fullest extent permitted by law.
7.2 Limitation of Liability. No provider or Surrogate shall incur civil or criminal liability for acts or omissions made in good faith pursuant to this Directive and in compliance with KRS § 311.629.
8. DISPUTE RESOLUTION
8.1 Governing Law. All disputes arising under this Directive shall be resolved in accordance with the laws of the Commonwealth of Kentucky without regard to conflict-of-laws principles.
8.2 Forum Selection. Any judicial proceeding shall be brought in a court of competent jurisdiction in [COUNTY], Kentucky.
8.3 Arbitration & Jury Waiver. [INTENTIONALLY OMITTED — not applicable per metadata.]
8.4 Preservation of Injunctive Relief. Nothing herein shall preclude any party from seeking provisional or injunctive relief as provided in Section 6.2.
9. GENERAL PROVISIONS
9.1 Amendment. The Principal may amend this Directive at any time in writing, signed and dated in accordance with the execution formalities of Section 10.
9.2 Revocation. This Directive may be revoked at any time by (i) a signed, dated writing; (ii) physical destruction of the original by the Principal; or (iii) oral expression of intent to revoke in the presence of the Attending Physician or other health-care provider, consistent with KRS § 311.631.
9.3 Severability. If any provision of this Directive is found invalid or unenforceable, the remaining provisions shall remain in full force and effect.
9.4 Integration. This Directive constitutes the entire statement of the Principal’s health-care instructions and supersedes all prior instruments concerning the subject matter herein.
9.5 Copies. A photocopy, facsimile, or electronically transmitted copy of this executed Directive shall have the same force and effect as the original.
9.6 Electronic Signatures. Execution by electronic signature in compliance with the Kentucky Uniform Electronic Transactions Act is permitted.
10. EXECUTION BLOCK
[// GUIDANCE: Kentucky requires EITHER (i) two qualified adult witnesses OR (ii) acknowledgment before a notary public. Choose ONE of the following subsections.]
10.1 Signature of Principal
I, [PRINCIPAL’S FULL LEGAL NAME], sign my name to this Directive on the date below and declare that I understand its purpose and effect.
Signature: _____ Date: _____
Address: ___________
OPTION A — TWO (2) ADULT WITNESSES
We, the undersigned witnesses, certify that: (1) the Principal is personally known to us, is of sound mind, and signed or acknowledged this Directive in our presence; (2) we are not related to the Principal by blood, marriage, or adoption; (3) we are not entitled to any portion of the Principal’s estate; (4) we are not responsible for the Principal’s medical care; and (5) we are at least eighteen (18) years old.
Witness #1 Signature: _____
Print Name: ____
Address: ______
Date: _______
Witness #2 Signature: _____
Print Name: ____
Address: ______
Date: _______
OPTION B — NOTARIZATION
COMMONWEALTH OF KENTUCKY )
) SS:
COUNTY OF __ )
On this ___ day of __, 20, before me, the undersigned Notary Public, personally appeared [PRINCIPAL’S NAME], known to me (or satisfactorily proven) to be the person whose name is subscribed to this instrument, and acknowledged that he/she executed the same for the purposes therein contained.
Notary Public Signature: _____
Print Name: ______
Commission No.: _____
My Commission Expires: _______
[// GUIDANCE: Provide executed copies to (i) each Surrogate, (ii) the Principal’s primary physician, and (iii) the admitting facility upon hospitalization. Consider uploading to the Kentucky Living Will Registry, if available.]
© 20__ [LAW FIRM / AUTHOR]. All rights reserved. Unauthorized reproduction is prohibited.