UNOFFICIAL COPY 23 RS BR 1759
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AN ACT relating to medical procedures. 1
Be it enacted by the General Assembly of the Commonwealth of Kentucky: 2
ď˘Section 1. KRS 311.625 is amended to read as follows: 3
(1) A living will directive made pursuant to KRS 311.623 shall be substantially in the 4
following form, and may include other specific directions which are in accordance 5
with accepted medical practice and not specifically prohibited by any other statute. 6
If any other specific directions are held by a court of appropriate jurisdiction to be 7
invalid, that invalidity shall not affect the directive. 8
"Living Will Directive 9
My wishes regarding life-prolonging treatment and artificially provided nutrition and 10
hydration to be provided to me if I no longer have decisional capacity, have a terminal 11
condition, or become permanently unconscious have been indicated by checking and 12
initialing the appropriate lines below. By checking and initialing the appropriate lines, I 13
specifically: 14
.... Designate ........................ as my health care surrogate(s) to make health care decisions 15
for me in accordance with this directive when I no longer have decisional capacity. If 16
............................. refuses or is not able to act for me, I designate .............................. as 17
my health care surrogate(s). 18
Any prior designation is revoked. 19
If I do not designate a surrogate, the following are my directions to my attending 20
physician. If I have designated a surrogate, my surrogate shall comply with my wishes as 21
indicated below: 22
.... Direct that treatment be withheld or withdrawn, and that I be permitted to die naturally 23
with only the administration of medication or the performance of any medical treatment 24
deemed necessary to alleviate pain. 25
.... DO NOT authorize that life-prolonging treatment be withheld or withdrawn. 26
.... Authorize the withholding or withdrawal of artificially provided food, water, or other 27 UNOFFICIAL COPY 23 RS BR 1759
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artificially provided nourishment or fluids. 1
.... DO NOT authorize the withholding or withdrawal of artificially provided food, water, 2
or other artificially provided nourishment or fluids. 3
.... Authorize my surrogate, designated above, to withhold or withdraw artificially 4
provided nourishment or fluids, or other treatment if the surrogate determines that 5
withholding or withdrawing is in my best interest; but I do not mandate that withholding 6
or withdrawing. 7
.... Authorize the giving of all or any part of my body upon death for any purpose 8
specified in KRS 311.1929. 9
.... DO NOT authorize the giving of all or any part of my body upon death. 10
In the absence of my ability to give directions regarding the use of life-prolonging 11
treatment and artificially provided nutrition and hydration, it is my intention that this 12
directive shall be honored by my attending physician, my family, and any surrogate 13
designated pursuant to this directive as the final expression of my legal right to refuse 14
medical or surgical treatment and I accept the consequences of the refusal. 15
If I have been diagnosed as pregnant and that diagnosis is known to my attending 16
physician, this directive shall have no force or effect during the course of my pregnancy. 17
I understand the full import of this directive and I am emotionally and mentally 18
competent to make this directive. 19
Signed this .... day of .........., 19... 20
Signature and address of the grantor. 21
In our joint presence, the grantor, who is of sound mind and eighteen (18) years of age, or 22
older, voluntarily dated and signed this writing or directed it to be dated and signed for 23
the grantor. 24
Signature and address of witness. 25
Signature and address of witness. 26
OR 27 UNOFFICIAL COPY 23 RS BR 1759
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STATE OF KENTUCKY) 1
...........County) 2
Before me, the undersigned authority, came the grantor who is of sound mind and 3
eighteen (18) years of age, or older, and acknowledged that he or she voluntarily dated 4
and signed this writing or directed it to be signed and dated as above. 5
Done this .... day of ........, 19... 6
Signature of Notary Public or other officer. 7
Date commission expires:............. 8
Execution of this document restricts withholding and withdrawing of some medical 9
procedures. Consult Kentucky Revised Statutes or your attorney." 10
(2) An advance directive shall be in writing, dated, and signed by the grantor, or at the 11
grantor's direction, and either witnessed by two (2) or more adults in the presence of 12
the grantor and in the presence of each other, or acknowledged before a notary 13
public or other person authorized to administer oaths. None of the following shall 14
be a witness to or serve as a notary public or other person authorized to administer 15
oaths in regard to any advance directive made under this section: 16
(a) A blood relative of the grantor; 17
(b) A beneficiary of the grantor under descent and distribution statutes of the 18
Commonwealth; 19
(c) An employee of a health care facility in which the grantor is a patient, unless 20
the employee serves as a notary public; 21
(d) An attending physician of the grantor; or 22
(e) Any person directly financially responsible for the grantor's health care. 23
(3) A person designated as a surrogate pursuant to an advance directive may resign at 24
any time by giving written notice to the grantor; to the immediate successor 25
surrogate, if any; to the attending physician; and to any health care facility which is 26
then waiting for the surrogate to make a health care decision. 27 UNOFFICIAL COPY 23 RS BR 1759
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(4) An employee, owner, director, or officer of a health care facility where the grantor 1
is a resident or patient shall not be designated or act as surrogate unless related to 2
the grantor within the fourth degree of consanguinity or affinity or a member of the 3
same religious or fraternal order. 4