Declaration, who may execute requirements ofdeclaration--form--witnesses required, when--notice tophysician--filed--where.
459.015. 1. Any competent person may execute a declarationdirecting the withholding or withdrawal of death-prolongingprocedures. The declaration made pursuant to sections 459.010 to459.055 shall be:
(1) In writing;
(2) Signed by the person making the declaration, or byanother person in the declarant's presence and by the declarant'sexpressed direction;
(3) Dated; and
(4) If not wholly in the declarant's handwriting, signed inthe presence of two or more witnesses at least eighteen years ofage neither of whom shall be the person who signed thedeclaration on behalf of and at the direction of the personmaking the declaration.
2. It shall be the responsibility of the declarant toprovide for notification to his attending physician of theexistence of the declaration. Upon the request of the patient,the declaration shall be placed in the declarant's medicalrecords as maintained by his attending physician and the medicalrecords of any health facility of which he is a patient.
3. The declaration may be in the following form, but itshall not be necessary to use this sample form. In addition, thedeclaration may include other specific directions. Should any ofthe other specific directions be held to be invalid, suchinvalidity shall not affect other directions of the declarationwhich can be given effect without the invalid declaration, and tothis end the directions in the declaration are severable.
DECLARATION
I have the primary right to make my own decisions concerningtreatment that might unduly prolong the dying process. By thisdeclaration I express to my physician, family and friends myintent. If I should have a terminal condition it is my desirethat my dying not be prolonged by administration ofdeath-prolonging procedures. If my condition is terminal and Iam unable to participate in decisions regarding my medicaltreatment, I direct my attending physician to withhold orwithdraw medical procedures that merely prolong the dying processand are not necessary to my comfort or to alleviate pain. It isnot my intent to authorize affirmative or deliberate acts oromissions to shorten my life rather only to permit the naturalprocess of dying.
Signed this ................... day of ....................,............ .
Signature ...................................City, County and State of residence ............................
............................
The declarant is known to me, is eighteen years of age orolder, of sound mind and voluntarily signed this document in mypresence.
Declaration, who may execute requirements ofdeclaration--form--witnesses required, when--notice tophysician--filed--where.
459.015. 1. Any competent person may execute a declarationdirecting the withholding or withdrawal of death-prolongingprocedures. The declaration made pursuant to sections 459.010 to459.055 shall be:
(1) In writing;
(2) Signed by the person making the declaration, or byanother person in the declarant's presence and by the declarant'sexpressed direction;
(3) Dated; and
(4) If not wholly in the declarant's handwriting, signed inthe presence of two or more witnesses at least eighteen years ofage neither of whom shall be the person who signed thedeclaration on behalf of and at the direction of the personmaking the declaration.
2. It shall be the responsibility of the declarant toprovide for notification to his attending physician of theexistence of the declaration. Upon the request of the patient,the declaration shall be placed in the declarant's medicalrecords as maintained by his attending physician and the medicalrecords of any health facility of which he is a patient.
3. The declaration may be in the following form, but itshall not be necessary to use this sample form. In addition, thedeclaration may include other specific directions. Should any ofthe other specific directions be held to be invalid, suchinvalidity shall not affect other directions of the declarationwhich can be given effect without the invalid declaration, and tothis end the directions in the declaration are severable.
DECLARATION
I have the primary right to make my own decisions concerningtreatment that might unduly prolong the dying process. By thisdeclaration I express to my physician, family and friends myintent. If I should have a terminal condition it is my desirethat my dying not be prolonged by administration ofdeath-prolonging procedures. If my condition is terminal and Iam unable to participate in decisions regarding my medicaltreatment, I direct my attending physician to withhold orwithdraw medical procedures that merely prolong the dying processand are not necessary to my comfort or to alleviate pain. It isnot my intent to authorize affirmative or deliberate acts oromissions to shorten my life rather only to permit the naturalprocess of dying.
Signed this ................... day of ....................,............ .
Signature ...................................City, County and State of residence ............................
............................
The declarant is known to me, is eighteen years of age orolder, of sound mind and voluntarily signed this document in mypresence.
Declaration, who may execute requirements ofdeclaration--form--witnesses required, when--notice tophysician--filed--where.
459.015. 1. Any competent person may execute a declarationdirecting the withholding or withdrawal of death-prolongingprocedures. The declaration made pursuant to sections 459.010 to459.055 shall be:
(1) In writing;
(2) Signed by the person making the declaration, or byanother person in the declarant's presence and by the declarant'sexpressed direction;
(3) Dated; and
(4) If not wholly in the declarant's handwriting, signed inthe presence of two or more witnesses at least eighteen years ofage neither of whom shall be the person who signed thedeclaration on behalf of and at the direction of the personmaking the declaration.
2. It shall be the responsibility of the declarant toprovide for notification to his attending physician of theexistence of the declaration. Upon the request of the patient,the declaration shall be placed in the declarant's medicalrecords as maintained by his attending physician and the medicalrecords of any health facility of which he is a patient.
3. The declaration may be in the following form, but itshall not be necessary to use this sample form. In addition, thedeclaration may include other specific directions. Should any ofthe other specific directions be held to be invalid, suchinvalidity shall not affect other directions of the declarationwhich can be given effect without the invalid declaration, and tothis end the directions in the declaration are severable.
DECLARATION
I have the primary right to make my own decisions concerningtreatment that might unduly prolong the dying process. By thisdeclaration I express to my physician, family and friends myintent. If I should have a terminal condition it is my desirethat my dying not be prolonged by administration ofdeath-prolonging procedures. If my condition is terminal and Iam unable to participate in decisions regarding my medicaltreatment, I direct my attending physician to withhold orwithdraw medical procedures that merely prolong the dying processand are not necessary to my comfort or to alleviate pain. It isnot my intent to authorize affirmative or deliberate acts oromissions to shorten my life rather only to permit the naturalprocess of dying.
Signed this ................... day of ....................,............ .
Signature ...................................City, County and State of residence ............................
............................
The declarant is known to me, is eighteen years of age orolder, of sound mind and voluntarily signed this document in mypresence.
