Introduction to the Living Will (Free Form included)

Briefly, a living will is a present statement that a person does not want to be kept on life support if they are suffering from a terminal condition, but that they would prefer to receive only comfort care at that point.  There is a statutory form that can be accessed for free at www.kslegislature.org by searching for the statute K.S.A. 65-28,103.  I prefer the following form, which accomplishes the same thing but reads more clearly.  It is provided free of cost to you, dear reader.  And with a small amount of creative formatting, it fits on a single page.

LIVING WILL

Pursuant to K.A.R. 65-28,101 et seq.

By signing this document, I declare the following:

1.    I am of sound mind, and this declaration is made willingly and voluntarily.  I fully understand and accept the importance of this document and its consequences.

2.    If the following conditions are ever present, I wish to be allowed to die naturally.

a.    I have an incurable medical condition, whether injury, disease, or illness;

b.    two physicians, including my attending physician, have examined me and certified that the condition is terminal, which shall include a permanently vegetative state; and

c.     the physicians have determined that my death will occur regardless of life-sustaining procedures, which would serve only to artificially prolong the dying process.

3.    If the above conditions occur and I am unable to give directions regarding life-sustaining procedures, this declaration shall be honored as my legal right to refuse medical or surgical treatment, and my death shall not be artificially prolonged.  Further:

a.    Life-sustaining procedures shall be withheld and withdrawn; but

b.    Any medicine may be administered, or medical procedures performed, for comfort care.

4.    Life-sustaining procedures shall include any procedure that would serve only to artificially prolong the dying process, including but not limited to nutrition or hydration administered by invasive procedures, antibiotics, respirators, pacemakers, renal dialysis, transfusion, and cardiac or cardiopulmonary resuscitation.

5.    My intention is to withhold life-sustaining procedures if they would not provide a substantial probability of removing the medical condition or providing me with a meaningful life.  But I have no intention of limiting any comfort care that is available to ease my passing.

6.    If I have named a surrogate for health care decisions or appointed an agent pursuant to a power of attorney to make health care decisions for me, he or she may provide consent for withholding or withdrawing life-prolonging procedures but shall not have the authority to override this document.  I release and hold harmless any person who, in good faith, terminates life-sustaining procedures in accordance with the guidelines in this declaration.

7.    This document is void during any period that I am pregnant, regardless of viability or term.

Signed:            ____________________________________           Date:   _________________

                        Printed Name:________________________

STATE OF KANSAS            )

COUNTY OF __________     )

This instrument was acknowledged before me on _________________ by ________________.

Signed: ___________________________

Printed Name:______________________