Living Will/Advance Directive

RHODE ISLAND ADVANCE HEALTH CARE DIRECTIVE

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

Statutory Framework: R.I. Gen. Laws §§ 23-4.10-1 et seq. (Durable Power of Attorney for Health Care Act) and §§ 23-4.11-1 et seq. (Living Will Act)

TABLE OF CONTENTS

1. Document Header
2. Definitions

3. Operative Provisions
   3.1 Appointment of Health Care Agent
   3.2 Living Will (End-of-Life Instructions)
   3.3 HIPAA Authorization
   3.4 Anatomical Gifts (Optional)
   3.5 Nomination of Guardian (Optional)

4. Representations & Warranties

5. Covenants & Restrictions
6. Default & Remedies
7. Risk Allocation
8. Dispute Resolution
9. General Provisions
10. Revocation Procedures
11. Execution Block

1. DOCUMENT HEADER

This Rhode Island Advance Health Care Directive (this “Directive”) is entered into by [FULL LEGAL NAME], residing at [ADDRESS] (“Principal”), effective as of [EFFECTIVE DATE] and governed by the laws of the State of Rhode Island.

Recitals

A. Principal desires to ensure that medical treatment decisions made on Principal’s behalf reflect Principal’s wishes in the event Principal is unable to communicate such wishes personally.
B. Principal further desires to appoint a trusted individual to act as Principal’s health care agent with authority to make health care decisions in accordance with this Directive and Rhode Island law.
C. Consideration is acknowledged by the mutual promises and undertakings herein.

2. DEFINITIONS

For purposes of this Directive, capitalized terms have the meanings set forth below:

“Agent” means the individual designated in Section 3.1 to act for the Principal with respect to health care decisions.

“Alternate Agent” means the successor representative(s) designated to serve if the Agent is unable or unwilling to act.

“Artificial Nutrition and Hydration” means medically administered food or fluids, including but not limited to feeding tubes and intravenous infusions.

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

“Life-Sustaining Treatment” means any medical treatment that serves only to prolong the process of dying or maintain vital functions without reasonable hope of recovery.

“Principal” has the meaning assigned in Section 1.

“Reasonable Medical Judgment” means a decision consistent with generally accepted medical standards as applied by the Principal’s attending physician.

“Revocation” means any act permitted under Rhode Island law that cancels or withdraws this Directive.

3. OPERATIVE PROVISIONS

3.1 Appointment of Health Care Agent

a. Designation. Principal hereby appoints [AGENT NAME], residing at [ADDRESS], telephone [PHONE], as Principal’s Agent.
b. Alternate Agent(s). If the Agent is unwilling, unavailable, or unable to act, Principal appoints in the following order of priority:

1. [FIRST ALTERNATE NAME, ADDRESS, PHONE]
2. [SECOND ALTERNATE NAME, ADDRESS, PHONE]

c. Scope of Authority. Subject to the limitations expressly stated herein, the Agent is authorized to make any and all health care decisions that the Principal could make if capable, including but not limited to consent, refusal, or withdrawal of treatment, admission to or discharge from health care facilities, and access to medical records.

3.2 Living Will (End-of-Life Instructions)

a. Terminal Condition or Persistent Vegetative State. If, in the judgment of the Attending Physician, the Principal (i) has an incurable or irreversible condition that will result in death within a relatively short time, or (ii) is permanently unconscious with no reasonable expectation of recovery, then the Principal directs that Life-Sustaining Treatment [SELECT ONE: be withheld or withdrawn / continue as long as medically feasible].
b. Artificial Nutrition and Hydration. Principal [SELECT ONE: does / does not] wish to receive Artificial Nutrition and Hydration when Life-Sustaining Treatment is withdrawn.
c. Pain Relief. Regardless of any other instruction, Principal requests treatment to alleviate pain and suffering even if it may hasten death.

3.3 HIPAA Authorization

Principal authorizes any covered entity under 45 C.F.R. § 164.502(a) to disclose Principal’s protected health information to the Agent to the same extent as Principal.

3.4 Anatomical Gifts (Optional)

Principal [SELECT ONE: does / does not] wish to make anatomical gifts under R.I. Gen. Laws § 23-18.6-1 et seq.
If yes, specify: [ORGANS/TISSUES/WHOLE BODY, PURPOSE(S)].

3.5 Nomination of Guardian (Optional)

Should a court decide that a guardian must be appointed, Principal nominates the Agent (or if unavailable, the Alternate Agent) to serve as guardian of the person.

4. REPRESENTATIONS & WARRANTIES

4.1 Capacity. Principal represents that Principal is of sound mind, at least eighteen (18) years of age, and under no duress or undue influence.
4.2 Reliance. Health care providers, institutions, and other third parties may rely on copies of this Directive as though originals.
4.3 Non-Revocation. Principal warrants that no prior advance directive remains in effect or, if any exists, it is hereby revoked pursuant to Section 10.

5. COVENANTS & RESTRICTIONS

5.1 Good-Faith Standard. The Agent shall act in good faith, consistent with the Principal’s instructions and best interests.
5.2 Consultation Duty. Where medically feasible, the Agent shall consult with the Principal’s treating physicians and immediate family before making major decisions.
5.3 Recordkeeping. The Agent shall maintain a written record of major decisions and rationale and make such record available upon reasonable request.

6. DEFAULT & REMEDIES

6.1 Removal of Agent. If two (2) physicians, one of whom is the Attending Physician, determine the Agent is acting contrary to the Principal’s expressed wishes or in bad faith, the Alternate Agent shall immediately assume authority.
6.2 Judicial Relief. Any interested person may petition the Rhode Island Superior Court for injunctive or declaratory relief regarding the construction or enforcement of this Directive.

7. RISK ALLOCATION

7.1 Indemnification. Principal’s estate shall indemnify and hold harmless any Agent or health care provider who, in good-faith reliance on this Directive, acts or refrains from acting.
7.2 Limitation of Liability. No Agent or health care provider acting in good faith pursuant to this Directive shall incur civil or criminal liability beyond the good-faith standard imposed by R.I. Gen. Laws §§ 23-4.10-12 and 23-4.11-9.

8. DISPUTE RESOLUTION

8.1 Governing Law. This Directive shall be governed by and construed in accordance with the laws of the State of Rhode Island, without regard to conflicts-of-law principles.
8.2 Injunctive Relief. Nothing herein limits the right of any party to seek injunctive relief to enforce or prevent the violation of this Directive.

9. GENERAL PROVISIONS

9.1 Amendment. Principal may amend this Directive at any time by executing a written instrument signed, dated, and witnessed in accordance with R.I. Gen. Laws § 23-4.11-3.
9.2 Revocation. See Section 10.
9.3 Severability. If any provision is held invalid, the remaining provisions shall remain in full force.
9.4 Integration. This Directive constitutes the entire advance directive of the Principal and supersedes any prior inconsistent directives.
9.5 Copies and Electronic Signatures. Photographic, facsimile, and electronically signed counterparts shall be as valid as originals.

10. REVOCATION PROCEDURES

The Principal may revoke this Directive in whole or in part by:
a. A signed, dated writing expressing intent to revoke;
b. Physically destroying or directing another to destroy the original Directive;
c. An oral statement of intent to revoke, made in the presence of a witness eighteen (18) years of age or older; or
d. Execution of a subsequent advance directive.

Revocation is effective upon communication to the Attending Physician or health care provider.

11. EXECUTION BLOCK

I, [FULL LEGAL NAME], the Principal, sign my name to this Rhode Island Advance Health Care Directive on [DATE] at [CITY, STATE].

PRINCIPAL:
________________________________________
Signature

Printed Name: ___________________________

11.1 WITNESS ATTESTATION

We declare that the Principal is personally known to us, appears to be of sound mind and under no duress, and thatthe Principal signed or acknowledged this Directive in our presence.

1. ________________________________________
   Signature of Witness
   Printed Name: ___________________________
   Address: ________________________________
   Date: ___________________________________

2. ________________________________________
   Signature of Witness
   Printed Name: ___________________________
   Address: ________________________________
   Date: ___________________________________

11.2 NOTARIZATION (Optional but Recommended)

State of Rhode Island
County of ________________

On this ___ day of __________, 20___, before me, the undersigned notary public, personally appeared ______________________________, proved to me through satisfactory evidence of identification to be the person whose name is signed on this document, and acknowledged to me that such person executed the same voluntarily for its stated purpose.

________________________________________
Notary Public
My Commission Expires: ________________

[ATTACHMENT A] – OPTIONAL ORGAN DONATION FORM

[Insert statutory organ donation language if client opts in.]

[ATTACHMENT B] – REVOCATION NOTICE (BLANK)

“I, ____________________________, hereby revoke my Advance Health Care Directive executed on _____________.
Signature: ___________________________
Date: ________________________________
Witness: _____________________________”

© [YEAR] [LAW FIRM NAME]. This template is provided for attorney drafting use only and does not constitute legal advice. Customize to client-specific facts and verify compliance with any statutory amendments prior to execution.