{"data":{"id":"us-ky/krs-311.625","jurisdiction":"us-ky","citation":"KRS 311.625","heading":"Form of living will directive.","body":"(1) A living will directive made pursuant to KRS 311.623 shall be substantially in the\nfollowing form, and may include other specific directions which are in accordance\nwith accepted medical practice and not specifically prohibited by any other statute.\nIf any other specific directions are held by a court of appropriate jurisdiction to be\ninvalid, that invalidity shall not affect the directive.\n\"Living Will Directive\nMy wishes regarding life -prolonging treatment and artificially provided nutrition and\nhydration to be provided to me if I no longer have decisional capacity, have a terminal\ncondition, or become permanently unconscious have been indicated by checking and\ninitialing the appropriate lines below. By checking and initialing the appropriate lines, I\nspecifically:\n.... Designate ........................ as my health care surrogate(s) to make health care decisions\nfor me in accordance with this directive when I no longer have decisional capacity. If\n............................. refuses or is not able to ac t for me, I designate .............................. as\nmy health care surrogate(s).\nAny prior designation is revoked.\nIf I do not designate a surrogate, the following are my directions to my attending\nphysician. If I have designated a surrogate, my surrog ate shall comply with my wishes as\nindicated below:\n.... Direct that treatment be withheld or withdrawn, and that I be permitted to die naturally\nwith only the administration of medication or the performance of any medical treatment\ndeemed necessary to alleviate pain.\n.... DO NOT authorize that life-prolonging treatment be withheld or withdrawn.\n.... Authorize the withholding or withdrawal of artificially provided food, water, or other\nartificially provided nourishment or fluids.\n.... DO NOT authorize the w ithholding or withdrawal of artificially provided food, water,\nor other artificially provided nourishment or fluids.\n.... Authorize my surrogate, designated above, to withhold or withdraw artificially\nprovided nourishment or fluids, or other treatment if t he surrogate determines that\nwithholding or withdrawing is in my best interest; but I do not mandate that withholding\nor withdrawing.\n.... Authorize the giving of all or any part of my body upon death for any purpose\nspecified in KRS 311.1929.\n.... DO NOT authorize the giving of all or any part of my body upon death.\nIn the absence of my ability to give directions regarding the use of life -prolonging\ntreatment and artificially provided nutrition and hydration, it is my intention that this\ndirective shall be honored by my attending physician, my family, and any surrogate\ndesignated pursuant to this directive as the final expression of my legal right to refuse\nmedical or surgical treatment and I accept the consequences of the refusal.\nIf I have bee n diagnosed as pregnant and that diagnosis is known to my attending\nphysician, this directive shall have no force or effect during the course of my pregnancy.\nI understand the full import of this directive and I am emotionally and mentally\ncompetent to make this directive.\nSigned this .... day of .........., 19...\nSignature and address of the grantor.\nIn our joint presence, the grantor, who is of sound mind and eighteen (18) years of age, or\nolder, voluntarily dated and signed this writing or directed it  to be dated and signed for\nthe grantor.\nSignature and address of witness.\nSignature and address of witness.\nOR\nSTATE OF KENTUCKY)\n...........County)\nBefore me, the undersigned authority, came the grantor who is of sound mind and\neighteen (18) years of age, or older, and acknowledged that he voluntarily dated and\nsigned this writing or directed it to be signed and dated as above.\nDone this .... day of ........, 19...\nSignature of Notary Public or other officer.\nDate commission expires:.............\nExecution of this document restricts withholding and withdrawing of some medical\nprocedures. Consult Kentucky Revised Statutes or your attorney.\"\n(2) An advance directive shall be in writing, dated, and signed by the grantor, or at the\ngrantor's direction, and either witnessed by two (2) or more adults in the presence of\nthe grantor and in the presence of each other, or acknowledged before a notary\npublic or other person authorized to administer oaths. None of the following shall\nbe a witness to or serve as a notary public or other person authorized to administer\noaths in regard to any advance directive made under this section:\n(a) A blood relative of the grantor;\n(b) A beneficiary of the grantor under descent and distribution statutes of the\nCommonwealth;\n(c) An employee of a health care facility in which the grantor is a patient, unless\nthe employee serves as a notary public;\n(d) An attending physician of the grantor; or\n(e) Any person directly financially responsible for the grantor's health care.\n(3) A person designated as a surrogate pursuant to an advance directive may resign at\nany time by giving written notice to the grantor; to the immediate successor\nsurrogate, if any; to the attending physician; and to any health care facility which is\nthen waiting for the surrogate to make a health care decision.\n(4) An employee, owner, director, or officer of a health care facility where the grantor\nis a resident or patient shall not be designated or act as surrogate unless related to\nthe grantor within the fourt h degree of consanguinity or affinity or a member of the\nsame religious or fraternal order.","path":["KRS Chapter 311"],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=42591","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:58:05Z","sha256":"d7dd310f50f80cfcd2d045f8535d80a7e92fd29daea20b7004fcb9c425c81225","source_id":"us-ky","stale":false,"prev":"us-ky/krs-311.624","next":"us-ky/krs-311.626"},"notice":"GroundRules: Original legal text. Not legal advice."}