Kansas statutes make two legal documents available to you
to make sure your wishes are followed. One is known as a
"living will" or natural death act declaration. The second
is the durable power of attorney for health care decisions
or health care power of attorney. You may also be able to
execute documents which differ from statutory forms. These
so-called "common-law" forms can be discussed with your
lawyer.
What is a living will?
A statutory living will is a written statement of your
wishes regarding your medical treatment if you are in a
terminal condition. It is only effective if two physicians
have determined you are terminally ill.
What is a durable power of attorney for health care
decisions?
A durable power of attorney for health care decisions is
a written document in which you authorize someone who you
name (your "agent" or "attorney-in-fact") to make health
care decisions for you in the event you are unable to speak
for yourself. Health care decisions include the power to
consent, refuse consent or withdraw consent to any type
of medical care, treatment, service or procedure. In the
document you can give specific instructions regarding your
health care which will require the agent to make decisions
in accordance with your direction.
What is the difference between a health care power of
attorney and a "living will"?
Power of attorney can cover all medical decisions.
Statutory living wills only apply to decisions regarding
"life-sustaining treatment" in the event of a "terminal
illness." A terminal illness does not include Alzheimer's
Disease, dementia or coma. A durable health care power of
attorney can be effective any time or, if you want, at any
time you are unable to make or communicate a decision. The
agent you appoint can make any decision you direct, including
decisions about health care beyond those covered by your
living will. For example, the agent under a durable power
of attorney can make decisions about care if you are in
a persistent vegetative state, but are not terminally ill.
Power of attorney appoints an agent
Through a durable power of attorney, you appoint someone
to act on your behalf. That person can weigh the pros and
cons of treatment decisions in accordance with your directions.
Unless you limit the powers, the agent can hire physicians
and other health care providers, decide where you will receive
treatment, and make decisions about the full range of medical
decisions from routine care to decisions about life-sustaining
treatment.
Do I lose control by appointing an agent?
You can write your living will and your durable power
of attorney to include specific limitations about anything
you want to have done or want to avoid having done. You
can express your wishes about whatever you care most about.
You can terminate your health care power of attorney at
any time by notifying your agent and health care provider.
You can terminate the power of attorney verbally but it
is best to do so in writing and to destroy the original
document.
Why do I need a living will or health care power of
attorney?
Without these documents, your wishes may not be followed.
In some situations a guardian may be limited in making some
decisions, especially those regarding life-sustaining treatment
when you are in a vegetative state but not terminally ill.
In addition, the guardian appointed by the court may have
no idea what your wishes are. The existence of the document
can relieve some of the stress or conflict that otherwise
might arise if family or friends have to decide on their
own what you would want done when you cannot speak for yourself.
Do I need both the living will and the durable power
of attorney?
It is recommended you have both documents. The living
will provides clear evidence of your wishes concerning medical
care and treatment and will help ensure that the agent and
physicians carry out your wishes. The durable power of attorney
for health care gives your agent the authority to take action
on your behalf and to carry out your directions for health
care, without the delays of court proceedings.
How do I make a living will and durable power of attorney
for health care?
The legislature has adopted statutory forms for both
the living will and the durable power of attorney. Those
forms are included in this pamphlet. In addition, a lawyer
can draft a document which specifically incorporates your
wishes and may be more detailed. Take time to consider all
the possibilities and seek competent advice so the documents
you develop meet your special needs.
Once I have the documents what do I do?
Even as you draft the documents you should talk about
your values and wishes with your physician(s), anyone you
will appoint as an agent or alternate agent, and those who
are close to you. You should give a copy of the documents
to all of your physicians, your agent under the durable
power of attorney, and your family or friends. If you retain
the originals tell someone where the papers can be found.
Place the originals in a secure place where someone can
access without court intervention.
Remember, a Living Will and Durable Power of Attorney
for Health Care Decisions provide you a way to maintain
control of your health care.
LIVING WILLS
Declaration
Declaration made this ___________________ day of _______________________(month,
year) I, ____________________________ being of sound mind,
willfully and voluntarily make known my desire that my dying
shall not be artificially prolonged under the circumstances
set forth below, do hereby declare:
If at any time I should have an incurable injury, disease,
or illness certified to be a terminal condition by two physicians
who have personally examined me, one of whom shall be my
attending physician, and the physicians have determined
that my death will occur whether or not life-sustaining
procedures are utilized and where the application of life-sustaining
procedures would serve only to artificially prolong the
dying process, I direct that such procedures 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.
In the absence of my ability to give directions regarding
the use of such life-sustaining procedures, it is my intention
that this declaration shall be honored by my family and
physician(s) as the final expression of my legal right to
refuse medical or surgical treatment and accept the consequences
from such refusal. I understand the full import of this
declaration and I am emotionally and mentally competent
to make this declaration.
Signed ___________________________________
City, County and State of Residence
____________________________________
The declarant has been personally known to me and I believe
him or her to be of sound mind. I did not sign the declarant's
signature above for or at the direction of the declarant.
I am not related to the declarant by blood or marriage,
entitled to any portion of the estate of the declarant according
to the laws of intestate succession of under any will of
declarant or codicil thereto, or directly financially responsible
for declarant's medical care.
Witness ________________________________
Witness ________________________________
DURABLE POWER OF ATTORNEY FOR HEALTH CARE DECISIONS GENERAL
STATEMENT OF AUTHORITY GRANTED.
I, __________________________________designate and appoint:
Name _________________________________________________
Address _______________________________________________
Telephone Number _____________________________________
to be my agent for health care decisions and pursuant to
the language stated below, on behalf to:
(1) Consent, refuse consent, or withdraw consent to any
care, treatment, service or procedure to maintain, diagnose
or treat a physical or mental condition, and to make decisions
about organ donation, autopsy and disposition of the body;
(2) Make all necessary arrangements at any hospital, psychiatric
hospital or psychiatric treatment facility, hospice, nursing
home or similar institution; to employ or discharge health
care personnel to include physicians, psychiatrists, psychologists,
dentists, nurses, therapists or any other person who is
licensed, certified or otherwise authorized or permitted
by the laws of this state to administer health care as the
agent shall deem necessary for my physical, mental and emotional
well-being; and
(3) Request, receive and review any information, verbal
or written, regarding my personal affairs or physical or
mental health including medical and hospital records and
to execute any releases of other documents that may be required
in order to obtain such information.
In exercising the grant of authority set forth above my
agent for health care shall:
__________________________________________
(Here may be inserted any special instructions or statement
of the principal's desired to be followed by the agent in
exercising the authority granted.)
LIMITATIONS OF AUTHORITY
(1) The powers of the agent herein shall be limited
to the extent set out in writing in this durable power of
attorney for health care decisions, and shall not include
the power to revoke or invalidate any previously existing
declaration made in accordance with the natural death act.
(2) The agent shall be prohibited from authorizing consent
for the following items:
__________________________________________
__________________________________
(3) This durable power of attorney for health care decisions
shall be subject to the additional following limitations:
_________________________________________
__________________________________________
EFFECTIVE TIME
This power of attorney for health care decisions shall
become effective immediately and shall not be affected by
my subsequent disability or incapacity or upon the occurrence
of my disability or incapacity.
REVOCATION
Any durable power of attorney for health care decisions
I have previously made is thereby revoked. (This durable
power of attorney for health care decisions shall be revoked
by an instrument in writing executed, witnessed or acknowledged
in the same manner as required herein or set out in another
manner of revocation, if desired.)
EXECUTION
Executed this _____________, at _____________, Kansas _____________________
(Principal.)
This document must be: (1) witnessed by two individuals
of lawful age who are not the agent, not related to the
principal by blood, marriage or adoption, not entitled to
any portion of principal's estate and not financially responsible
for principal's health care: OR (2) acknowledged by a notary
public.
_________________________________
Witness
_________________________________
Address
(or)
STATE OF _______________________________)
COUNTY OF _____________________________)
This instrument was acknowledged before me on
_______________________________________
(date)
by ______________________________________
(name of person)
__________________________________________
(signature of notary public)
(Seal, if any)
My appointment expires: __________________ Copies
