Missouri Healthcare Directive

In Missouri, advance care planning usually takes two documents. A durable power of attorney for health care names an agent to make medical decisions when you cannot, and a Life Support Declaration, Missouri's living will, tells your doctors whether to withhold treatment that only prolongs dying. Many people sign both in one form.

Use this Missouri 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. A Missouri estate-planning attorney can help you sign documents that say what you mean. This page connects to the Missouri probate and estate directory and to the Missouri estate planning basics guide for the rest of your plan.

What a Missouri Health Care Directive Covers

Missouri keeps two ideas in separate statutes, and a full plan usually addresses both. Here is how they split.

• A durable power of attorney for health care lets you name an agent, called an attorney in fact, to consent to or refuse treatment, choose providers, and see your medical information when you cannot decide for yourself. This sits in the Durable Power of Attorney for Health Care Act (RSMo 404.800 to 404.865). (Source: RSMo 404.800.)
• A Life Support Declaration, Missouri's version of a living will, records your own instruction to withhold or withdraw death-prolonging procedures if your condition becomes terminal. This sits in the Life Support Declaration Act (RSMo Chapter 459). (Source: RSMo 459.015.)

The Missouri Department of Health and Senior Services posts an advance health care directive form that folds both parts into one document, so you can sign the agent appointment and the terminal-care instruction together. You can use that form, adapt it, or write your own, as long as each part meets its own signing rule.

Naming a Health Care Agent

Your agent steps into your shoes for medical decisions, so choose an adult you trust, ask them first, and consider naming a successor agent as a backup. Missouri limits who can serve. Your treating physician, or an owner or employee of a facility where you live, cannot act as your agent unless they are related to you within the second degree or belong to the same religious community bound by vows (RSMo 404.815). Your agent is meant to decide based on your known wishes and your medical diagnosis, so talk through your values before you sign. (Source: RSMo 404.815.)

How to Sign It in Missouri

The two documents follow different signing rules, so check each one.

• The durable power of attorney for health care must be in writing, dated, signed by you, and acknowledged before a notary public, the same formality Missouri uses for a real estate deed. The document also has to say the authority survives your disability or incapacity, which is what makes it durable (RSMo 404.705, applied to health care powers by RSMo 404.810). Missouri does not require witnesses for this document, though the state form leaves room for them.
• The Life Support Declaration must be in writing, signed, and dated. If it is not entirely in your own handwriting, you sign it in front of two witnesses who are at least 18 and who are not the person signing for you (RSMo 459.015).

A safer approach is to avoid using your agent or anyone who would inherit from you as a witness, so no one can question the signing later. Confirm the current signing rules and the state form before you sign, or ask a Missouri attorney to walk through them with you.

When Your Agent Can Act

A Missouri durable power of attorney for health care does not hand over control the moment you sign it. Unless your document says otherwise, your agent's authority starts only after two licensed physicians examine you and certify in writing that you cannot make your own health care decisions. One of the two can be your attending physician, and the attending physician re-checks the finding over time (RSMo 404.825). While you can still decide for yourself, you stay in charge, and your own choices control. (Source: RSMo 404.825.)

The Life Support Declaration and Terminal Care

Missouri draws a tight line around what a Life Support Declaration can do. It becomes operative only when two things are true at once: your condition is terminal, and you can no longer make treatment decisions. Both findings go in your medical record, and a declaration has no effect during pregnancy (RSMo 459.025).

The declaration reaches only death-prolonging procedures, meaning care that would serve only to prolong the dying process when death will come within a short time either way. Missouri reads comfort care and pain relief out of that definition, and it also reads out any procedure that provides nutrition or hydration (RSMo 459.010). So a Life Support Declaration on its own cannot direct the withdrawal of a feeding tube.

If you want an agent to be able to stop artificially supplied nutrition and hydration, Missouri makes you grant that power in plain words inside the durable power of attorney for health care. Even then, your agent cannot act with the intent of causing your death, and cannot withhold food or water you can still take by natural means (RSMo 404.820). This split is why many Missourians sign both documents rather than a living will alone.

Changing or Revoking It

Neither document expires on its own, and you can change course while you can communicate.

• You can revoke a Life Support Declaration at any time and in any way you can show your intent, whatever your mental or physical condition. The provider notes the revocation in your medical record (RSMo 459.020).
• You can revoke a durable power of attorney for health care at any time by telling your agent, your doctor, or another provider. Signing a new valid health care power of attorney also cancels an earlier one, unless the document says otherwise (RSMo 404.850).

After any change, tell your agent and your providers, and replace any copies they hold so an old version does not resurface.

Missouri's Advance Directive Registry

Since 2017, Missouri has run a secure online Advance Health Care Directives Registry through a contracted vendor for the Department of Health and Senior Services. You can store your directive, your Life Support Declaration, and any revocation so hospitals can find them in an emergency. Registration is optional, the fee is capped at ten dollars, and documents go in electronically through a licensed provider or attorney. Skipping the registry does not make your documents any less valid (RSMo 459.250). Keep your own signed copies too, and give one to your agent and your doctor.

A Simple Planning Sequence

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

1. Decide whether you want a named agent, written terminal-care instructions, or both in one document.
2. Choose your health care agent and a successor, and ask them before you name them.
3. Write your care wishes, including whether your agent may stop artificially supplied nutrition and hydration.
4. Sign the durable power of attorney for health care before a notary, and sign the Life Support Declaration before two witnesses.
5. Give signed copies to your agent and your doctor, and consider the state registry.
6. Review both documents after any major change, and replace them if your wishes change.

Pair these documents with the rest of your plan. The Missouri estate planning basics guide covers the wills, trusts, and beneficiary choices that move your property, and the Missouri will requirements guide covers what makes a will valid. For the full set of Missouri estate and probate pages, start at the Missouri estate directory.

This Missouri healthcare directive guide is general information about Missouri estates and incapacity planning. The Life Support Declaration Act, the Durable Power of Attorney for Health Care Act, and the official Revised Statutes of Missouri control. Confirm anything that affects your situation with a licensed Missouri attorney.

Sources:

• Title: RSMo 404.800, Durable Power of Attorney for Health Care Act, short title. Publisher: Missouri Revised Statutes (Missouri General Assembly). Publication Date: Effective August 28, 1991. URL: https://revisor.mo.gov/main/OneSection.aspx?section=404.800
• Title: RSMo 404.815, Physician or health care facility not to serve as attorney in fact, exceptions. Publisher: Missouri Revised Statutes (Missouri General Assembly). Publication Date: Effective August 28, 1991. URL: https://revisor.mo.gov/main/OneSection.aspx?section=404.815
• Title: RSMo 404.820, Withdrawing or withholding treatment, specific authority required. Publisher: Missouri Revised Statutes (Missouri General Assembly). Publication Date: Effective August 28, 1991. URL: https://revisor.mo.gov/main/OneSection.aspx?section=404.820
• Title: RSMo 404.825, Examination of patient required, content. Publisher: Missouri Revised Statutes (Missouri General Assembly). Publication Date: Effective August 28, 1991. URL: https://revisor.mo.gov/main/OneSection.aspx?section=404.825
• Title: RSMo 459.010, Definitions, Life Support Declarations. Publisher: Missouri Revised Statutes (Missouri General Assembly). Publication Date: Not listed. URL: https://revisor.mo.gov/main/OneSection.aspx?section=459.010
• Title: RSMo 459.015, Declaration, who may execute, requirements, form, witnesses. Publisher: Missouri Revised Statutes (Missouri General Assembly). Publication Date: Effective August 28, 1985. URL: https://revisor.mo.gov/main/OneSection.aspx?section=459.015
• Title: RSMo 459.025, Declaration operative, when. Publisher: Missouri Revised Statutes (Missouri General Assembly). Publication Date: Not listed. URL: https://revisor.mo.gov/main/OneSection.aspx?section=459.025
• Title: RSMo 459.250, Advance Health Care Directives Registry established. Publisher: Missouri Revised Statutes (Missouri General Assembly). Publication Date: Effective August 28, 2017. URL: https://revisor.mo.gov/main/OneSection.aspx?section=459.250
• Title: Advance Directives. Publisher: Missouri Department of Health and Senior Services. Publication Date: Accessed July 17, 2026. URL: https://health.mo.gov/atoz/

It is not legal advice.