Kentucky Healthcare Directive

Kentucky folds your health care wishes into one document. Under the Kentucky Living Will Directive Act, KRS 311.621 to 311.643, a single written living will directive names a health care surrogate to speak for you, records your wishes about life-prolonging treatment, and can even make an anatomical gift. You sign it before two adult witnesses or a notary, and no lawyer is required to make it valid.

Use this Kentucky healthcare directive guide as a planning map, not as legal advice or a finished form. The right wording depends on your health, your family, and what you want at the end of life. A Kentucky estate planning attorney can confirm your documents say what you mean. This page connects to the Kentucky probate and estate directory, the Kentucky will requirements guide, the Kentucky estate planning basics guide, and the guide on how to avoid probate in Kentucky for the rest of your plan.

What Kentucky's Living Will Directive Covers

Kentucky uses one combined document. A written living will directive may do any or all of four things (KRS 311.623(1)):

• Name one or more adults as your health care surrogate, plus a successor surrogate, to make health care decisions when you no longer have decisional capacity.
• Direct that life-prolonging treatment be withheld or withdrawn.
• Direct that artificially provided nutrition and hydration be withheld or withdrawn.
• Give all or part of your body upon death as an anatomical gift under KRS 311.1929.

The statutory form sits at KRS 311.625, and you record each wish by checking and initialing the matching line. You may add other directions that fit accepted medical practice and are not barred by another statute. If a court later strikes one added direction, the rest of the directive still stands.

Choosing a Health Care Surrogate

Your surrogate steps into your shoes for medical decisions, so pick an adult you trust, ask them before you name them, and add a backup. A surrogate may make any health care decision you could make yourself, as long as each choice follows the wishes in your directive and weighs your attending physician's recommendation (KRS 311.629). Two limits shape the role. Your surrogate may not act in any situation where your attending physician has determined in good faith that you still have decisional capacity (KRS 311.629(2)). And if two or more surrogates serve at once, they must agree unanimously unless your directive says otherwise (KRS 311.623(1)(c)).

Kentucky also blocks a conflict of interest at care facilities. An employee, owner, director, or officer of a health care facility where you live or are a patient may not act as your surrogate unless they are related to you within the fourth degree of consanguinity or affinity, or belong to the same religious or fraternal order (KRS 311.625(4)). A surrogate may step down at any time by written notice to you, the successor surrogate, your attending physician, and any facility waiting on a decision (KRS 311.625(3)).

How to Sign It in Kentucky

KRS 311.625(2) gives you two signing routes, and you only need one. Put the directive in writing, date it, and sign it (or direct someone to sign for you). Then either:

• Two or more adult witnesses. Sign in the joint presence of two or more adults, who watch you and each other sign.
• A notary. Sign or acknowledge the directive before a notary public or another officer authorized to administer oaths.

Kentucky bars several people from witnessing or notarizing the directive (KRS 311.625(2)):

• a blood relative,
• anyone who would inherit from you under Kentucky's descent and distribution statutes,
• an employee of the health care facility where you are a patient, unless that employee serves as the notary,
• your attending physician, and
• anyone directly responsible for paying your health care costs.

You must be of sound mind and at least 18 to make the directive (KRS 311.621(1)). Extra witness signatures, or a notary stamp you did not need, do no harm.

When the Directive Takes Effect

Your treatment directions do not switch on the day you sign. They apply only after you no longer have decisional capacity and you either have a terminal condition or have become permanently unconscious (KRS 311.625(1)). Kentucky defines both conditions tightly, and each rests on two doctors, not one:

• A terminal condition is an incurable and irreversible condition that, judged by your attending physician and one other physician, will cause death within a relatively short time, where treatment would only prolong dying (KRS 311.621(17)).
• Permanently unconscious means your attending physician and one other physician find, on clinical examination, an absence of the brain functions that show consciousness or interaction with your surroundings (KRS 311.621(13)).

Medication or a procedure to relieve pain never counts as life-prolonging treatment, so comfort care continues either way (KRS 311.621(11)).

Artificially Provided Nutrition and Hydration

Kentucky treats food and fluids as a separate decision on the form. You initial one of three choices: authorize withholding or withdrawal of artificial nutrition and hydration, decline to authorize it, or let your surrogate decide in your best interest (KRS 311.625(1)). Read that block slowly before you initial anything.

Even when you authorize it, a surrogate may withhold or withdraw artificial nutrition and hydration only in four situations (KRS 311.629(3)):

• inevitable death is imminent, meaning death is expected within a few days by reasonable medical judgment,
• you are permanently unconscious and your directive authorized the withdrawal,
• your body cannot physically assimilate the nutrition, or
• the burden of providing it outweighs its benefit.

In none of these situations may food or fluids be withheld if you need them for comfort or relief of pain (KRS 311.629(3)).

The Pregnancy Limit

A Kentucky living will directive has no force or effect during a pregnancy that your attending physician knows about (KRS 311.625(1)). A related rule requires that life-sustaining treatment and artificial nutrition and hydration continue for a pregnant patient unless your attending physician and one other examining physician certify on your chart that the treatment will not let the pregnancy continue to a live birth, will physically harm you, or will prolong severe pain that medication cannot relieve (KRS 311.629(4)).

If You Never Sign a Directive

Kentucky fills the gap with a ranked list of people who may decide for you, called responsible parties (KRS 311.631). When an adult patient lacks decisional capacity and signed no directive, or the directive does not cover a decision, authority passes to the first person on this list who is available, willing, and able to act:

1. a court-appointed guardian, if medical decisions fall within the guardianship,
2. an agent under a durable power of attorney that expressly covers health care decisions,
3. your spouse,
4. an adult child, or a majority of your adult children,
5. your parents,
6. your nearest living relative, or a majority of relatives of the same degree,
7. an adult friend who has kept regular contact and knows your health and beliefs.

Kentucky updated this list in 2024 through a law named Seth's Law (2024 Ky. Acts ch. 138). Every decision made this way goes in your medical record (KRS 311.631(2)), and a general hospital may not hold you for psychiatric treatment beyond fourteen days without a court order (KRS 311.631(4)). The ladder works, but it hands your care to a default ranking instead of the person you would have picked. Naming your own surrogate keeps that choice in your hands.

MOST Forms and Out-of-Hospital DNR Orders

Two medical orders sit alongside your directive. A Kentucky Medical Order for Scope of Treatment, or MOST form, is a portable order your physician signs with you for a serious illness. It covers resuscitation, the scope of treatment, artificial food and fluids, and antibiotics, and a doctor reviews it at least once a year (KRS 311.6225). If a MOST form and your living will ever give conflicting directions, your living will wins (KRS 311.6225). For emergencies outside a hospital, crews honor a wish not to be resuscitated only when it appears on a form or identification approved by the Kentucky Board of Medical Licensure or on an approved MOST form (KRS 311.623(3)). Ask your doctor about both once an illness turns serious, because these are medical orders, not papers you sign at your kitchen table.

Changing or Revoking It

A Kentucky directive carries no expiration date, so it stays in force until you revoke it. You keep three ways to revoke while you can communicate (KRS 311.627):

• Sign and date a writing that declares you intend to revoke.
• Say out loud that you revoke it, in front of two adults, one of whom is a health care provider. A spoken revocation by a grantor with decisional capacity overrides any earlier written directive.
• Destroy the document yourself, or have someone destroy it in your presence and at your direction.

You may also revoke or narrow a surrogate designation on its own, or cut back the surrogate's authority, at any time. Signing a new designation cancels the old one unless you say otherwise (KRS 311.627(4)). A revocation takes effect at once, but your physician or facility does not have to act on it until they get notice, so tell your providers and replace old copies after any change (KRS 311.627(3)).

A Simple Planning Sequence

Use this order as a starting checklist, then confirm the details with a Kentucky attorney or your doctor.

1. Choose your health care surrogate and a backup, and ask them before you name them.
2. Write out your wishes about life-prolonging treatment and about artificial nutrition and hydration.
3. Decide whether to add an anatomical gift.
4. Sign before two adult witnesses or a notary, and check the disqualified-witness rules first.
5. Give signed copies to your surrogate, your doctor, and your hospital.
6. Review the directive after a serious diagnosis, a marriage, a divorce, or a move, and replace old copies whenever your wishes change.

Pair this document with the rest of your plan. A Kentucky power of attorney handles your money and property if you cannot act, the Kentucky will requirements guide covers what makes a will valid, and the Kentucky intestate succession guide explains who inherits without one. The Kentucky probate and estate directory links the full set of state pages.

This Kentucky healthcare directive guide is general information about incapacity planning in the Commonwealth. The Kentucky Living Will Directive Act and the official Kentucky Revised Statutes control. Confirm anything that affects your situation with a licensed Kentucky attorney.

Sources:

• Title: KRS 311.621, Definitions for KRS 311.621 to 311.643 (advance directive, decisional capacity, grantor, life-prolonging treatment, permanently unconscious, responsible party, surrogate, terminal condition). Publisher: Kentucky General Assembly, Legislative Research Commission. Publication Date: Effective June 24, 2015; accessed July 20, 2026. URL: https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=44034
• Title: KRS 311.625, Form of living will directive (execution in subsection (2): two or more adult witnesses or a notary; witness and notary disqualifications; surrogate resignation; facility-employee surrogate limit). Publisher: Kentucky General Assembly, Legislative Research Commission. Publication Date: Effective June 25, 2013; accessed July 20, 2026. URL: https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=42591
• Title: KRS 311.629, Powers of health care surrogate (scope; no action while grantor has capacity; nutrition and hydration limits; pregnancy). Publisher: Kentucky General Assembly, Legislative Research Commission. Publication Date: Effective July 15, 1994; accessed July 20, 2026. URL: https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=30567
• Title: KRS 311.631, Responsible parties authorized to make health care decisions (seven-tier default priority list; fourteen-day psychiatric cap), as amended by Seth's Law. Publisher: Kentucky General Assembly, Legislative Research Commission. Publication Date: Effective July 15, 2024; accessed July 20, 2026. URL: https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=55099
• Title: KRS 311.627, Revocation of an advance directive (writing; oral statement before two adults including a provider; destruction; surrogate-designation revocation). Publisher: Kentucky General Assembly, Legislative Research Commission. Publication Date: Effective July 15, 1994; accessed July 20, 2026. URL: https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=30565
• Title: KRS 311.6225, Kentucky MOST form (eligible persons; scope; living will prevails over a conflicting MOST form; annual review). Publisher: Kentucky General Assembly, Legislative Research Commission. Publication Date: Effective July 15, 2024; accessed July 20, 2026. URL: https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=55380

It is not legal advice.