Kansas Statutes 65-28,103. Same; declaration authorizing; effect during pregnancy of qualified patient; duty to notify attending physician; form of declaration; severability of directions
(a) Any adult person may execute a declaration directing the withholding or withdrawal of life-sustaining procedures in a terminal condition. The declaration made pursuant to this act shall be: (1) In writing; (2) signed by the person making the declaration, or by another person in the declarant’s presence and by the declarant’s expressed direction; (3) dated; and (4)(A) signed in the presence of two or more witnesses at least 18 years of age neither of whom shall be the person who signed the declaration on behalf of and at the direction of the person making the declaration, 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 this state or under any will of the declarant or codicil thereto, or directly financially responsible for declarant’s medical care; or (B) acknowledged before a notary public. The declaration of a qualified patient diagnosed as pregnant by the attending physician shall have no effect during the course of the qualified patient’s pregnancy.
(b) It shall be the responsibility of declarant to provide for notification to the declarant’s attending physician of the existence of the declaration. An attending physician who is so notified shall make the declaration, or a copy of the declaration, a part of the declarant’s medical records.
Terms Used In Kansas Statutes 65-28,103
- Attending physician: means the physician selected by, or assigned to, the patient who has primary responsibility for the treatment and care of the patient. See Kansas Statutes 65-28,102
- Codicil: An addition, change, or supplement to a will executed with the same formalities required for the will itself.
- Declaration: means a witnessed document in writing, voluntarily executed by the declarant in accordance with the requirements of Kan. See Kansas Statutes 65-28,102
- Intestate: Dying without leaving a will.
- Physician: means a person licensed to practice medicine and surgery by the state board of healing arts. See Kansas Statutes 65-28,102
- Qualified patient: means a patient who has executed a declaration in accordance with this act and who has been diagnosed and certified in writing to be afflicted with a terminal condition by two physicians who have personally examined the patient, one of whom shall be the attending physician. See Kansas Statutes 65-28,102
- Residence: means the place which is adopted by a person as the person's place of habitation and to which, whenever the person is absent, the person has the intention of returning. See Kansas Statutes 77-201
- State: when applied to the different parts of the United States, includes the District of Columbia and the territories. See Kansas Statutes 77-201
(c) The declaration shall be substantially in the following form, but in addition may include other specific directions. Should any of the other specific directions be held to be invalid, such invalidity shall not affect other directions of the declaration which can be given effect without the invalid direction, and to this end the directions in the declaration are severable.
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 the declarant 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 or under any will of declarant or codicil thereto, or directly financially responsible for declarant’s medical care.
Witness ___________________________________________ Witness ___________________________________________
(OR)
STATE OF ____________________)
______________________________ ss.
COUNTY OF ____________________)
This instrument was acknowledged before me on ________ (date) by ______________________ (name of person)
____________________________________________________
(Signature of notary public)
(Seal, if any)
My appointment expires: ________________________
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