Missouri Revised Statutes













Chapter 459

Declarations, Life Support

←459.010

Section 459.015.1

459.020→

August 28, 2015

Declaration, who may execute requirements of declaration--form--witnesses required, when--notice to physician--filed--where.

459.015. 1. Any competent person may execute a declaration directing the

withholding or withdrawal of death-prolonging procedures. The declaration

made pursuant to sections 459.010 to 459.055 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) If not wholly in the declarant's handwriting, signed in the presence

of two or more witnesses at least eighteen 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.



2. It shall be the responsibility of the declarant to provide for

notification to his attending physician of the existence of the declaration.

Upon the request of the patient, the declaration shall be placed in the

declarant's medical records as maintained by his attending physician and the

medical records of any health facility of which he is a patient.



3. The declaration may be in the following form, but it shall not be

necessary to use this sample form. In addition, the declaration 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 declaration, and to

this end the directions in the declaration are severable. DECLARATION



I have the primary right to make my own decisions concerning treatment

that might unduly prolong the dying process. By this declaration I express

to my physician, family and friends my intent. If I should have a terminal

condition it is my desire that my dying not be prolonged by administration of

death-prolonging procedures. If my condition is terminal and I am unable to

participate in decisions regarding my medical treatment, I direct my

attending physician to withhold or withdraw medical procedures that merely

prolong the dying process and are not necessary to my comfort or to alleviate

pain. It is not my intent to authorize affirmative or deliberate acts or

omissions to shorten my life rather only to permit the natural process of

dying.



Signed this ............... day of ................, ........ .



Signature



...................................... City, County and State of residence



......................................



.....................

.................



The declarant is known to me, is eighteen years of age or older, of sound

mind and voluntarily signed this document in my presence.



Witness

.....................................



Address

.....................................



Witness

.....................................



Address

.....................................



REVOCATION PROVISION



I hereby revoke the above declaration.



Signed

.........................................



(Signature of Declarant)



Date

.............................................



(L. 1985 S.B. 51 § 2)







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Missouri General Assembly



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