Kentucky: Living Will and Advance Health-Care Instruction Requirements
The short answer
Kentucky uses a written living will directive under the Kentucky Living Will Directive Act. An adult with decisional capacity must date and sign the directive, or direct another person to sign, and use either at least two qualified adult witnesses who sign together in the adult's presence or an acknowledgment before a notary or other oath officer. The statutory form separates life-prolonging treatment from artificial nutrition and hydration; during pregnancy, the form says the directive has no force, while a separate section requires treatment unless two physicians certify one of three statutory exceptions.
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This is the general rule in Kentucky. Ezel applies current Kentucky law to your specific facts and answers with citations to the statutes.
| Governing law and document | Kentucky Living Will Directive Act, KRS §§ 311.621–311.643: written 'living will directive.' It must substantially follow § 311.625's form, but may add medically accepted directions not otherwise prohibited (§§ 311.625(1), 311.637(6)) |
|---|---|
| Who may make an instruction | An adult—age 18+ and of sound mind—with decisional capacity, meaning ability to make and communicate a health-care decision (§§ 311.621(1), (5); 311.623(1)) |
| Oral, written, and signature form | Written, dated, signed by the adult or at the adult's direction (§ 311.625(2)). No general oral creation route. The Act supplies no express electronic-execution procedure |
| Witness, notary, and disqualifications | Either 2+ adult witnesses, all signing in the adult's and each other's presence, OR acknowledgment before a notary/oath officer (§ 311.625(2)). Neither witness nor officer may be a blood relative, intestate beneficiary, attending physician, person directly responsible for care costs, or facility employee except an employee acting as notary |
| Covered conditions and trigger | The statutory form addresses loss of decisional capacity, terminal condition, or permanent unconsciousness (§ 311.625(1)). Terminal condition and permanent unconsciousness each use attending physician + 1 other physician findings (§ 311.621(13), (17)); a capable adult retains ordinary decision rights (§ 311.637(5)) |
| Treatment, nutrition, hydration, and comfort | May separately direct withholding/withdrawal of life-prolonging treatment and artificial food/fluids, or direct their continuation (§§ 311.623(1), 311.625(1)). Pain-relief medication/procedures are outside 'life-prolonging treatment' (§ 311.621(11)). A surrogate's nutrition/hydration authority has narrower § 311.629(3) limits |
| Pregnancy and other statutory limits | The printed form says the directive has no force during a known pregnancy (§ 311.625(1)); separately, § 311.629(4) requires life-sustaining treatment and artificial nutrition/hydration unless 2 examining physicians certify inability to support development/live birth, physical harm, or severe unrelievable pain. Act does not authorize mercy killing/euthanasia (§ 311.639) |
| Revocation, notice, and registry | Revoke immediately by signed dated writing, directed destruction in the adult's presence, or—while decisionally capable—oral statement before 2 adults, 1 a provider (§ 311.627). Providers need notice before changing treatment and must record notice time, date, and place. The Act creates no directive registry |
| Provider duties, recognition, and effect | Directive must be honored, subject to statutory refusal (§ 311.623(2)). Refuser immediately informs patient/representatives, cannot impede an authorized transfer, and supplies records/assistance; written moral, religious, or professional objectors are protected if transfer rules are followed (§ 311.633). Good-faith compliance is protected and execution presumed valid (§ 311.635). No automatic foreign-form rule; other written directives consistent with accepted medical practice may be followed (§ 311.637(6)) |
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Kentucky's living will is a written directive under the Kentucky Living Will
Directive Act. It may contain treatment instructions and a surrogate
designation, but this page covers the adult's own instructions. A medical order
for scope of treatment is a separate clinician order and is outside this survey.
Requirements one by one
Kentucky requires the statutory form in substance
Under § 311.623, an adult with decisional capacity may make a written
directive addressing life-prolonging treatment and artificially provided
nutrition or hydration. Section § 311.625(1) says the directive must be
substantially in the printed form. It may add specific directions consistent
with accepted medical practice and not prohibited by another statute.
The maker must be at least 18, of sound mind, and able to make and communicate a
health-care decision under § 311.621. The Act provides no general oral route
for creating the directive.
The witnesses must sign together, or the adult may use acknowledgment
Section § 311.625(2) requires a written, dated directive signed by the adult
or at the adult's direction. The adult then chooses one of two execution paths:
at least two adults witness it in the adult's presence and in each other's
presence, or the adult acknowledges it before a notary or another person
authorized to administer oaths.
Every witness—and the acknowledgment officer—must avoid the same listed
conflicts. The person cannot be a blood relative, an intestate beneficiary, the
attending physician, someone directly financially responsible for the adult's
care, or an employee of the facility where the adult is a patient. A facility
employee may act as the notary.
The form names three future-care settings
The printed form addresses the adult's wishes if the adult loses decisional
capacity, has a terminal condition, or becomes permanently unconscious. Under
§ 311.621, a terminal condition is incurable and irreversible, is expected
to cause death within a relatively short time, and makes life-prolonging
treatment serve only to prolong dying. Permanent unconsciousness means the
specified absence of conscious cortical function. Each finding is made by the
attending physician and one other physician.
Section 311.637(5) preserves the capable adult's ordinary right to make a
current treatment decision. Signing the future directive does not replace the
adult's current choice while the adult can decide.
Treatment and artificial food and fluids are separate choices
The form in § 311.625(1) lets the adult separately authorize or reject
withholding life-prolonging treatment and artificially provided food, water,
or other nourishment or fluids. It preserves medication and treatment needed
to alleviate pain. The definition of life-prolonging treatment likewise
excludes those pain-relief measures.
When a surrogate rather than the adult's direct instruction controls the
nutrition decision, § 311.629(3) supplies narrower conditions. It lists
imminent death, authorized withdrawal during permanent unconsciousness,
inability to assimilate nutrition, or a burden greater than benefit. For the
first three listed circumstances, the subsection bars withdrawal when the
artificial nutrition and hydration is needed for comfort or pain relief.
Kentucky's two pregnancy provisions must be read together
The printed form in § 311.625(1) says the directive has no force or effect
during a pregnancy known to the attending physician. Separately,
§ 311.629(4) says life-sustaining treatment and artificially provided
nutrition and hydration must be provided despite an advance directive unless
the attending physician and one other examining physician certify one of three
conditions: the procedures will not maintain the woman for continued fetal
development and live birth, will physically harm the woman, or will prolong
severe pain that medication cannot alleviate.
The Act places both provisions in the same scheme. It does not authorize mercy
killing, euthanasia, or an affirmative or deliberate act to end life beyond
natural dying under § 311.639.
Revocation is immediate, but providers need notice
Under § 311.627, the adult may revoke by a signed and dated writing, by
destroying the document or directing its destruction in the adult's presence,
or—while having decisional capacity—by an oral statement before two adults,
one of whom is a health-care provider. The revocation is immediate, but a
physician or facility need not change treatment until receiving notice. The
provider records the time, date, and place of receipt. The Act creates no state
directive registry.
A refusing provider must disclose the refusal and allow transfer
Section 311.623(2) says the directive must be honored, subject to the
refusal rules. Under § 311.633, a refusing physician or facility immediately
informs the patient and listed representatives, does not impede an authorized
transfer, and supplies the records and assistance medically necessary for
continued care. An individual provider who objects in writing on moral,
religious, or professional grounds is protected if the notification and
transfer requirements are followed.
Good-faith statutory action receives the protections in § 311.635, and a
directive made under the Act is presumed voluntary and validly executed unless
the physician or facility actually knows otherwise. Kentucky does not state an
automatic place-of-execution rule for an out-of-state form. Section
311.637(6) instead preserves other written advance directives and allows
providers to follow them when consistent with accepted medical practice.
What trips people up
- The witnesses must be together. Each signs in the adult's presence and in
the presence of the other witnesses. - A notary is an alternative, not an added third signature. The same
conflict rules generally apply to the acknowledgment officer. - The pregnancy text appears in two places. The form's no-effect sentence
and the separate two-physician exceptions both belong in the analysis. - Nutrition and hydration are their own choice. The form does not make the
life-prolonging-treatment selection automatically decide artificial food and
fluids. - Oral revocation is narrower than oral creation. Kentucky recognizes the
specified oral revocation but does not create a general oral living will.
Common questions
May another person sign for me?
Yes. Section 311.625 allows signing at the adult's direction, but the witness or
acknowledgment requirements still apply.
Must I use witnesses and a notary?
No. The statute uses alternatives: at least two qualified adult witnesses or an
acknowledgment before a notary or another authorized oath officer.
Will Kentucky automatically accept a living will signed elsewhere?
The Act does not provide a categorical place-of-execution validity rule. It
does allow providers to follow other written advance directives that are
consistent with accepted medical practice.
Does signing the directive eliminate my current choice?
No. Section 311.637 preserves the decision rights of an adult who remains able
to make the decision.
Statutes and sources
- KRS § 311.621 — adult, capacity, written-directive, treatment, terminal,
and permanent-unconsciousness definitions. Official text
(accessed 2026-07-31). - KRS § 311.623 — permissible instructions and duty to honor the directive.
Official text
(accessed 2026-07-31). - KRS § 311.625 — required form, treatment choices, pregnancy sentence,
signature, witnesses, acknowledgment, and disqualifications. Official text
(accessed 2026-07-31). - KRS § 311.627 — revocation methods, effectiveness, notice, and medical
record. Official text
(accessed 2026-07-31). - KRS § 311.629 — surrogate nutrition limits and operative pregnancy rule.
Official text
(accessed 2026-07-31). - KRS § 311.633 — directive notice, refusal, objections, records, and
transfer. Official text
(accessed 2026-07-31). - KRS § 311.635 — immunity and voluntary-valid-execution presumption.
Official text
(accessed 2026-07-31). - KRS § 311.637 — current-capacity rights and other written directives.
Official text
(accessed 2026-07-31). - KRS § 311.639 — mercy-killing and euthanasia boundary. Official text
(accessed 2026-07-31). - KRS § 311.643 — short title. Official text
(accessed 2026-07-31).
Source links
Every statute quoted above, linked, with the date we checked it.
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