South Dakota: Living Will and Advance Health-Care Instruction Requirements

South Dakota uses a standalone written declaration under SDCL chapter
34-12D. The declaration governs withholding or withdrawal of life-sustaining
treatment and separately must address artificial nutrition and hydration. It is
not an appointment of a health-care agent.

Requirements one by one

The declaration needs a signature and either witnesses or a notary

Under § 34-12D-2, a competent adult signs personally or directs another
person to sign. The declaration then uses one of two alternatives: two adult
witnesses, or a notary public who notarizes it. Chapter 34-12D lists no
relationship, inheritance, provider, or facility disqualification for a
witness.

The printed § 34-12D-3 form is optional. It still displays signature lines
for the declarant, two witnesses, and a notary, but the current operative rule
in § 34-12D-2 makes witnesses and notarization alternatives. The form has a
date line; the execution sentence itself does not state a date requirement.
The chapter defines a declaration as a writing and supplies no oral or
electronic-specific creation route.

The attending physician makes the activating findings

Under § 34-12D-5, the declaration becomes operative when the attending
physician determines all three points: the declarant has a terminal condition,
death is imminent, and the declarant can no longer communicate decisions about
medical care.

The definition in § 34-12D-1(7) includes both an imminently fatal,
incurable and irreversible condition and a detailed indefinite-coma or
permanent-unconsciousness category. But § 34-12D-5 separately says death
must be imminent. The statutory form's permanent-unconsciousness wording should
therefore not be read as a free-standing trigger detached from the operative
section.

Feeding, hydration, and comfort are separate questions

Every declaration must state the declarant's preferences about providing,
withholding, or withdrawing artificial nutrition and hydration. If it does
not, § 34-12D-2 says the ordinary South Dakota law that applies without a
declaration governs that question.

The optional form separately offers prolong-life, do-not-prolong, and custom
treatment instructions, followed by a distinct feeding-and-hydration choice.
Under § 34-12D-1(4) and § 34-12D-9, life-sustaining treatment excludes
oral food and water, comfort, hygiene, human dignity, and medication or
procedures needed to alleviate pain; provider responsibility for those needs
continues.

What trips people up

• Pregnancy has a two-physician exception test. Life-sustaining treatment
  and artificial nutrition and hydration must be provided despite the
  declaration unless the attending physician and one other physician who has
  examined the woman certify on the medical chart, to a reasonable degree of
  medical certainty, that the procedures will not permit continuing development
  and live birth, will physically harm the woman, or will prolong severe pain
  that medication cannot alleviate (§ 34-12D-10).
• A capable patient still decides. § 34-12D-6 preserves a qualified
  patient's own decisions about life-sustaining treatment while the patient can
  make them.
• Revocation is deliberately broad. The declarant may revoke at any time
  and in any manner without regard to mental or physical condition. It becomes
  effective when communicated to a health-care provider, who must place it in
  the medical record (§ 34-12D-8).

Common questions

May I use a notary instead of two witnesses?
Yes. The current § 34-12D-2 sentence makes the two-adult-witness route and
the notary route alternatives, even though the older optional form displays
both blocks.

What if a provider will not withhold or withdraw treatment?
Under § 34-12D-11, the provider need not participate but must make a
reasonable effort to locate and transfer the declarant to a willing physician
or provider. A direction to provide technically feasible treatment or
artificial nutrition and hydration follows the different § 34-12D-12 rule:
an objecting provider may transfer, but must continue the directed care until
the transfer occurs.

Does South Dakota recognize a declaration signed elsewhere?
Under § 34-12D-22, a declaration is valid for purposes of the chapter if it
met the execution law of the jurisdiction where the declarant then lived, the
place of execution, or South Dakota.

Is there a state living-will registry?
Chapter 34-12D establishes no directive registry. Its notice system instead
depends on communication to providers and medical-record entries under
§ 34-12D-7 and § 34-12D-8.

Statutes and sources

• S.D. Codified Laws § 26-1-1 — age of minority. South Dakota Legislative
  Research Council (accessed 2026-07-31).
• S.D. Codified Laws §§ 34-12D-1 to -3 — definitions, execution, mandatory
  artificial-nutrition-and-hydration preference, and optional form. Same
  official source (accessed 2026-07-31).
• S.D. Codified Laws §§ 34-12D-5 to -12 — operative trigger, current patient
  choice, medical records, revocation, comfort, pregnancy, and provider transfer
  duties. Same official source (accessed 2026-07-31).
• S.D. Codified Laws §§ 34-12D-13 and -19 to -22 — immunity, accepted
  medical standards, statutory limits, presumed validity, and out-of-state
  execution. Same official source (accessed 2026-07-31).