OKLAHOMA ADVANCE DIRECTIVE FOR HEALTH CARE

(Living Will, Health Care Proxy & Anatomical Gift Instrument)

[// GUIDANCE: This court-ready template is drafted to comply with the Oklahoma Advance Directive Act, Okla. Stat. tit. 63, §§ 3101.1–3101.16 (2024). Insert client-specific information in the bracketed placeholders, delete guidance comments before final execution, and review all choices with the client.]

TABLE OF CONTENTS

1. Document Header
2. Definitions
3. Operative Provisions
    3.1 Designation of Health Care Proxy
    3.2 Treatment Instructions (Living Will)
    3.3 Anatomical Gifts
    3.4 Nomination of Guardian
4. Representations & Warranties
5. Covenants & Restrictions
6. Default & Remedies
7. Risk Allocation
8. General Provisions
9. Revocation Procedures
10. Execution Block

1. DOCUMENT HEADER

This Oklahoma Advance Directive for Health Care (the “Directive”) is made as of [EFFECTIVE DATE] (the “Effective Date”) by [FULL LEGAL NAME OF DECLARANT], residing at [ADDRESS] (the “Declarant”), pursuant to and in conformity with the Oklahoma Advance Directive Act, Okla. Stat. tit. 63, §§ 3101.1–3101.16.

2. DEFINITIONS

For purposes of this Directive, the following terms shall have the meanings set forth below. All defined terms are used in bold throughout this Directive.

a. “Advance Directive Act” means Okla. Stat. tit. 63, §§ 3101.1–3101.16, as amended.
b. “Artificially Administered Nutrition and Hydration” means the invasive provision of nutrients or fluids through medical or mechanical means, including but not limited to nasogastric tubes, gastrostomy tubes, and intravenous infusion.
c. “Attending Physician” means the physician directing and supervising the medical care of the Declarant.
d. “Health Care Proxy” means the individual designated in Section 3.1 to make health-care decisions on behalf of the Declarant when the Declarant lacks decision-making capacity.
e. “Life-Prolonging Treatment” means any medical procedure, treatment, or intervention that, when administered to a patient in a terminal condition, serves only to postpone the moment of death.
f. “Persistent Vegetative State” has the meaning set forth in the Advance Directive Act.
g. “Terminal Condition” means an incurable and irreversible condition that, without the administration of Life-Prolonging Treatment, will result in death within six (6) months.

3. OPERATIVE PROVISIONS

3.1 Designation of Health Care Proxy

1. Primary Proxy. I designate [PRIMARY PROXY NAME], whose address is [PRIMARY PROXY ADDRESS] and telephone number is [PRIMARY PROXY PHONE], to act as my Health Care Proxy.
2. Alternate Proxy. If the Primary Proxy is unable or unwilling to act, I designate [ALTERNATE PROXY NAME] at [ALTERNATE PROXY ADDRESS], phone [ALTERNATE PROXY PHONE].
3. Scope of Authority. My Health Care Proxy is authorized to:
   a. Consent to, refuse, or withdraw any health-care treatment, including Artificially Administered Nutrition and Hydration, consistent with Section 3.2 below;
   b. Employ or discharge health-care providers;
   c. Have access to my medical records as permitted under HIPAA;
   d. Authorize my admission to or discharge from a health-care facility;
   e. Take any lawful action necessary to carry out my expressed wishes.
4. Standards. The Proxy shall make decisions in good faith, consistent with my expressed desires herein and, if unknown, in my best interests.

[// GUIDANCE: Consider inserting HIPAA release language here if desired for belt-and-suspenders protection.]

3.2 Treatment Instructions (Living Will)

The following instructions apply if I am determined, in writing, by my Attending Physician and another qualified physician to be in a Terminal Condition, a Persistent Vegetative State, or otherwise permanently unconscious and unable to make or communicate decisions:

1. Life-Prolonging Treatment
   [SELECT ONE AND DELETE OTHERS]
   □ I direct that Life-Prolonging Treatment be withheld or withdrawn and that I be permitted to die naturally with only the administration of medication or the performance of any medical procedure deemed necessary to provide me with comfort care.
   □ I direct that Life-Prolonging Treatment continue unless it is deemed medically futile by my Attending Physician.

2. Artificially Administered Nutrition and Hydration
   [SELECT ONE AND DELETE OTHERS]
   □ I do not wish to receive Artificially Administered Nutrition and Hydration.
   □ I wish to receive Artificially Administered Nutrition and Hydration only if it may provide comfort.
   □ I wish to receive Artificially Administered Nutrition and Hydration in all circumstances.

3. Pain Management
   I direct that adequate pain relief be administered to alleviate suffering, even if such medication may inadvertently hasten my death.

4. Pregnancy
   If I am pregnant at the time this Directive would otherwise become operative, I direct that [DESCRIBE PREFERENCE IN ACCORD WITH OKLA. STAT. tit. 63, § 3101.4].

3.3 Anatomical Gifts

Upon my death, I make an anatomical gift of:
[SELECT ONE]
□ Any needed organs or tissues for transplantation, therapy, research, or education.
□ Only the following organs or tissues: [SPECIFY].
□ No anatomical gifts.

3.4 Nomination of Guardian

If a court deems a guardian necessary, I nominate my Health Care Proxy first and [ALTERNATE PROXY NAME] second to serve as my general guardian.

4. REPRESENTATIONS & WARRANTIES

The Declarant represents and warrants that:
a. The Declarant is at least eighteen (18) years of age and of sound mind.
b. The Declarant is executing this Directive voluntarily, free of duress or undue influence.
c. Any prior advance directive is hereby revoked in accordance with Section 9.

5. COVENANTS & RESTRICTIONS

a. The Health Care Proxy shall act in good faith and in accordance with the Declarant’s expressed wishes.
b. Health-care providers shall honor this Directive to the fullest extent permitted under applicable law.
c. No party may assign or delegate obligations under this Directive except as expressly provided herein or as required by law.

6. DEFAULT & REMEDIES

a. Failure of a provider to honor this Directive constitutes a breach of statutory duty under the Advance Directive Act.
b. The Declarant, or after incapacity the Health Care Proxy, may seek injunctive relief to enforce this Directive in any court of competent jurisdiction.
c. Reasonable attorney fees and costs shall be recoverable by a prevailing party enforcing this Directive.

7. RISK ALLOCATION

7.1 Indemnification

The Declarant agrees to indemnify and hold harmless any health-care provider who, in good-faith reliance upon this Directive, withholds or withdraws treatment in accordance herewith, from any civil or criminal liability to the fullest extent permitted by the Advance Directive Act (“provider protection”).

7.2 Limitation of Liability

No health-care provider, Health Care Proxy, or guardian acting under this Directive shall incur liability for actions taken in good faith pursuant to its terms (“good-faith standard”).

7.3 Force Majeure

Health-care providers shall not be deemed in default for failure to comply with this Directive if compliance is impossible due to acts of God, war, riot, or other circumstances beyond reasonable control; provided, they use diligent efforts to comply as soon as practicable.

8. GENERAL PROVISIONS

a. Governing Law. This Directive shall be governed by the laws of the State of Oklahoma without regard to conflicts-of-law principles.
b. Amendment & Waiver. This Directive may be amended only by a written instrument executed with the same formalities as this Directive. No waiver shall be effective unless in writing.
c. Severability. If any provision is held invalid or unenforceable, the remaining provisions shall remain in full force and effect.
d. Integration. This Directive constitutes the entire expression of the Declarant’s wishes regarding the subject matter herein and supersedes all prior directives.
e. Counterparts; Electronic Signatures. This Directive may be executed in multiple counterparts and by electronic signature, each of which shall be deemed an original.

9. REVOCATION PROCEDURES

1. Automatic Revocation. This Directive is revoked upon execution of a subsequent valid advance directive.
2. Express Written Revocation. The Declarant may revoke this Directive at any time by a signed, dated writing.
3. Oral Revocation. An oral statement of intent to revoke, made by the Declarant to the Attending Physician or two (2) witnesses, shall revoke this Directive upon documentation in the Declarant’s medical record.
4. Physical Act. Intentional destruction or cancellation of the original Directive by the Declarant or at the Declarant’s direction revokes this Directive.
5. Notice of Revocation. The Declarant (or person acting at the Declarant’s direction) shall notify the Health Care Proxy and all known health-care providers of the revocation as soon as practicable.

[// GUIDANCE: Attach Revocation Form as Schedule A if client desires a ready-to-use standalone revocation instrument.]

10. EXECUTION BLOCK

I have read and fully understand this Directive and the consequences of its provisions. I sign it willingly, and I execute it as my free and voluntary act.

DECLARANT
Signature: ______
Printed Name: ______
Date: _________

WITNESS ATTESTATION

We declare that:
1. The Declarant signed or acknowledged this Directive in our presence;
2. The Declarant appears to be of sound mind and is not executing this Directive under duress, fraud, or undue influence;
3. We are at least eighteen (18) years of age;
4. We are not the Declarant’s legatees, heirs at law, or named Health Care Proxy.

OPTIONAL NOTARIZATION

State of Oklahoma )
County of __ ) ss.

Subscribed and sworn to before me on this __ day of __, 20_, by [DECLARANT’S NAME].
Notary Public: ___
My Commission Expires: __
Commission No.: ______

[// GUIDANCE: Review with the client for consistency with any pre-existing health-care documents, verify witness eligibility, and ensure copies are provided to proxies and medical providers.]