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CONDITIONS
UNDER WHICH YOU MAY EXECUTE A LIVING WILL
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 If at any time you should have
an incurable and irreversible injury, disease, or illness certified in
writing to be a terminal condition by your attending physician and one
other qualified physician and or you have been unconscious, comatose, or otherwise incompetent so as to
be unable to make or communicate responsible decisions concerning your
person, you may direct that such procedures which
would only prolong the dying process be withheld or withdrawn, and that
you be permitted to die naturally with only the administration of
medication, sustenance, or the performance of any medical procedure
deemed necessary by your attending physician to provide you comfort
care.
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ADDITIONAL INFORMATION ABOUT THIS LIVING WILL |
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Designation of Health Care Agent
This
living will allows you to designated a health care surrogate. You
may also designate an alternate health care surrogate if your original
surrogate refuses or is not able to act for you. Your health care
surrogate, in consultation with your
attending physician, has the power and guidance to make health care decisions
according to your wishes when you are in a terminal condition and cannot
do so.
Your health care
surrogate has the same
right as you have to examine your medical records and to consent to their
disclosure for purposes related to your health care or insurance unless
you limit this right in this document.
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Anatomical Gifts
You may authorize the
giving of all or any part of your body for purpose specified in Kentucky
Revised Statutes 311.185 (anatomical gifts).
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Operative Date
Your living will becomes operative when a copy is provided to
your attending physician; and you are determined by
your attending physician to be incompetent and in a terminal condition or
in a state of permanent unconsciousness.
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Duty of Attending
Physician(s)
 When your living will becomes
operative, your physician and other health care providers shall act in
accordance with its provisions. If your attending physician or other
health care provider cannot in good conscience comply with the provisions
of your living will or if the policies of the health care provider
preclude compliance, your attending physician or health care provider
shall so inform you, or, if you are incompetent, shall so inform your
agent, or, if an agent is not named in your living will, shall so inform
your family, guardian or other representative. Your physician and
health care provider shall make every reasonable effort to assist in the
your transfer to another physician or health care provider who will comply
with your living will.
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Revocation
Your living will may be
revoked at any time and in any manner by you without regard to your mental
or physical condition. A revocation is effective upon communication
to your attending physician or other health care provider by you or a
witness to the revocation. Your attending physician or other health
care provider shall
make your revocation a part of your medical records.
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Executing and Delivering Your Living Will
After your declaration has been printed it must be signed in front of two
witnesses OR a notary public. The original should be submitted to your
physician for entry in your medical records. Copies should be made and
given to trusted family members.
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SOURCE: Kentucky Statutes §311.625; Form of Living Will
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