MISSOURI ADVANCE DIRECTIVE

(Combined Living Will & Durable Power of Attorney for Health Care)

TABLE OF CONTENTS

I. Document Header
II. Definitions
III. Operative Provisions
  A. Appointment of Health-Care Agent
  B. Statement of Health-Care Instructions
  C. Anatomical Gifts (Optional)
  D. HIPAA Authorization
IV. Representations & Warranties
V. Covenants & Restrictions
VI. Default & Remedies
VII. Risk Allocation
VIII. Dispute Resolution
IX. General Provisions
X. Execution Block (Signatures, Witnesses, Notary)

I. DOCUMENT HEADER

1. Title. Missouri Advance Directive (Living Will & Durable Power of Attorney for Health Care).
2. Declarant. [FULL LEGAL NAME], residing at [ADDRESS] (“Declarant”).
3. Health-Care Agents. (i) [PRIMARY AGENT NAME], (ii) [ALTERNATE AGENT #1], (iii) [ALTERNATE AGENT #2] (each a “Health-Care Agent”).
4. Effective Date. This instrument is effective on the later of (a) the date executed below, or (b) the date Declarant is determined to lack decision-making capacity by the attending physician in accordance with Chapter 459, Missouri Revised Statutes (“Mo. Rev. Stat.”).
5. Governing Law. This Advance Directive is governed by the laws of the State of Missouri and is intended to comply with Mo. Rev. Stat. Chapter 459 (Right to Life—Self-Determination) and §§ 404.800–404.865 (Durable Power of Attorney for Health Care).

[// GUIDANCE: Missouri does not require notarization, but notarization can streamline acceptance in other states and with certain health-care institutions.]

II. DEFINITIONS

For purposes of this Advance Directive, the following terms have the meanings set forth below. Terms defined herein and used elsewhere in the document appear with initial capital letters.

“Advance Directive” means this written declaration of health-care instructions and durable power of attorney for health care executed pursuant to Missouri law.

“Artificial Nutrition and Hydration” means medically provided sustenance via intravenous, gastrostomy, jejunostomy, or similar means.

“Attending Physician” means the physician having primary responsibility for Declarant’s care.

“Good Faith” means an honest belief, without gross negligence, malice, or conscious wrongdoing.

“Health-Care Agent” has the meaning set forth in Section III.A.

“Life-Prolonging Treatment” means any medical intervention or procedure that merely postpones the moment of death and does not provide a reasonable hope of recovery.

“Permanent Unconscious Condition” means an irreversible condition in which Declarant is permanently unaware of self and environment.

“Terminal Condition” means an incurable and irreversible condition that will, within reasonable medical judgment, result in death regardless of the continued administration of Life-Prolonging Treatment.

[// GUIDANCE: Add or delete definitions to fit client-specific preferences.]

III. OPERATIVE PROVISIONS

A. Appointment of Health-Care Agent

1. Grant of Authority. Declarant hereby appoints the Health-Care Agent(s) listed in Section I.3, in the listed order of priority, as attorney-in-fact with full authority to make any and all health-care decisions on Declarant’s behalf that Declarant could make personally, subject to the limitations set forth herein.
2. Scope. Authority includes, without limitation, the power to:
    a. Consent to, refuse, or withdraw any treatment;
    b. Admit or discharge Declarant from any health-care facility;
    c. Hire and discharge medical personnel;
    d. Access medical records;
    e. Make Anatomical Gifts under Section III.C.
3. Successor Agents. If a higher-priority Agent is unwilling, unable, or disqualified to act, the next-listed Agent shall serve.

B. Statement of Health-Care Instructions

1. End-of-Life Decisions. If Declarant is in a Terminal Condition or Permanent Unconscious Condition, Declarant directs that Life-Prolonging Treatment [SELECT ONE: be withheld / be continued].
2. Artificial Nutrition and Hydration. Declarant [SELECT ONE: does / does not] want Artificial Nutrition and Hydration when it merely prolongs the dying process.
3. Pain Relief. Declarant requests adequate pain relief even if it may hasten death, provided such medication is not specifically intended to cause death.
4. Pregnancy. If Declarant is pregnant, health-care decisions shall [SPECIFY PRIORITY, e.g., “prioritize the life of the unborn child unless continuation of treatment poses an unreasonable risk to Declarant’s life or health.”]

[// GUIDANCE: Missouri permits, but does not mandate, the inclusion of pregnancy directives.]

C. Anatomical Gifts (Optional)

Declarant hereby [SELECT ONE: makes / does not make] an anatomical gift of [SPECIFY ORGAN/TISSUE OR “ANY NEEDED”] for the purposes of [TRANSPLANT / THERAPY / RESEARCH / EDUCATION].

D. HIPAA Authorization

Declarant authorizes any covered entity under 45 C.F.R. § 164.502 to disclose protected health information to any Health-Care Agent for the purpose of exercising powers granted hereunder.

IV. REPRESENTATIONS & WARRANTIES

1. Declarant represents:
    a. Age & Capacity. Declarant is at least eighteen (18) years old and of sound mind.
    b. Voluntariness. Execution is voluntary and without duress or undue influence.
2. Witness Representations. Each witness signing below represents that the witness:
    a. Is at least eighteen (18) years old;
    b. Is not (i) related to Declarant by blood or marriage within the third degree, (ii) entitled to any portion of Declarant’s estate under any will or by operation of law, (iii) directly financially responsible for Declarant’s medical care, or (iv) a health-care provider or employee of a health-care facility in which Declarant is a patient.

V. COVENANTS & RESTRICTIONS

1. Health-Care Agent Fiduciary Duty. Each Health-Care Agent shall act in Good Faith, consistent with Declarant’s known wishes and best interests.
2. No Compensation. Health-Care Agents serve without compensation other than reimbursement of reasonable out-of-pocket expenses.
3. Non-Delegation. Health-Care Agents may not delegate decision-making authority except as expressly authorized by Missouri law.

VI. DEFAULT & REMEDIES

1. Breach by Health-Care Agent. Any action or omission by a Health-Care Agent that constitutes gross negligence, willful misconduct, or fraud shall be grounds for removal by a court of competent jurisdiction.
2. Injunctive Relief. Declarant (while competent) or any interested person may seek injunctive relief to enforce this Advance Directive.
3. Attorneys’ Fees. A prevailing party in any action to enforce or interpret this Advance Directive is entitled to reasonable attorneys’ fees and costs.

VII. RISK ALLOCATION

1. Provider Protection. Any health-care provider acting in Good Faith reliance on this Advance Directive or on the instructions of a Health-Care Agent shall be indemnified and held harmless by Declarant’s estate against all civil or criminal liability, except for acts of gross negligence or willful misconduct.
2. Limitation of Liability. Under no circumstances shall any health-care provider incur liability for following, or for refusing to follow, instructions that on their face violate applicable law or professional ethical standards.

VIII. DISPUTE RESOLUTION

1. Governing Law. This Advance Directive shall be construed in accordance with the laws of the State of Missouri, without regard to conflict-of-law principles.
2. Forum. Any dispute shall be brought in a court of competent jurisdiction located in [COUNTY], Missouri.
3. Arbitration & Jury Trial. Arbitration and jury-trial waivers are not applicable to this Advance Directive.

IX. GENERAL PROVISIONS

1. Revocation. Declarant may revoke this Advance Directive at any time by (a) a signed, dated writing, (b) physical destruction with intent to revoke, or (c) an oral statement of revocation in the presence of the Attending Physician and two witnesses.
2. Amendment. Declarant may amend this instrument only by executing a subsequent writing that complies with Missouri law.
3. Severability. If any provision is held invalid, the remaining provisions shall remain in full force.
4. Integration. This document constitutes the entire Advance Directive of Declarant and supersedes all prior directives.
5. Copies. Photocopies and electronically transmitted copies of this instrument have the same effect as an original.
6. Electronic Signatures. To the fullest extent permitted by Mo. Rev. Stat. and the Uniform Electronic Transactions Act, electronic signatures are binding.

X. EXECUTION BLOCK

DECLARANT
I, [DECLARANT NAME], sign my name to this Missouri Advance Directive on this [DAY] day of [MONTH, YEAR], at [CITY, STATE].

[DECLARANT SIGNATURE]

A. Witnesses

We declare that the Declarant signed or acknowledged this Advance Directive in our presence, appears to be of sound mind and under no duress, fraud, or undue influence, and that we are not disqualified persons under Missouri law.

B. Notary Public (OPTIONAL BUT RECOMMENDED)

State of Missouri )
County of __ ) ss.

On this _ day of _, 20__, before me, the undersigned Notary Public, personally appeared [DECLARANT NAME], known to me (or satisfactorily proven) to be the person whose name is subscribed to the foregoing instrument, and acknowledged that he/she executed the same for the purposes therein contained.

Notary Public
My Commission Expires: ______

[// GUIDANCE:
1. Provide copies to all named Health-Care Agents, primary physician(s), and relevant health-care facilities.
2. Registering the Directive with Missouri’s registry is optional but promotes rapid access.
3. Periodically review (at least every 2–3 years) and after major life events.
]