Missouri Living Will Requirements

Missouri's treatment-wishes declaration (informally called a living will) is authorized solely by the Life Support Declarations Act, Sections 459.010 to 459.055. This is a separate statute from Missouri's Durable Power of Attorney for Health Care Act (Sections 404.800-404.865), which covers naming an agent, not stating your own treatment wishes. The two acts have different execution rules and are not combined into one instrument.

A Missouri declaration must be signed by the declarant, or by another person in the declarant's presence and at the declarant's express direction. If the declaration is not wholly in the declarant's own handwriting, it must additionally be signed in the presence of two witnesses at least 18 years old. If it is wholly in the declarant's own handwriting, no witnesses are required at all.

Missouri's statutory witness requirement is narrower than commonly assumed. A witness must be at least 18 years old and must not be the person who signed the declaration on the declarant's behalf. The statute does not disqualify a witness for being related to the declarant, standing to inherit from the declarant, being financially responsible for the declarant's care, or being the declarant's health care provider or an employee of that provider. Avoiding such interested witnesses is a widely recommended best practice, not a Missouri legal requirement.

Missouri defines 'terminal condition' as an incurable or irreversible condition which, in the opinion of the attending physician, is such that death will occur within a short time regardless of the application of medical procedures. This is the only trigger condition Missouri's declaration statute recognizes.

A Missouri declaration may be revoked at any time and in any manner by which the declarant is able to communicate an intent to revoke, without regard to mental or physical condition. The attending physician or health care provider must make the revocation part of the medical record. There is no criminal or civil liability for failing to act on a revocation unless it is documented in the medical record or the person had actual knowledge of it.

Missouri's declaration has no effect during the entire course of the declarant's pregnancy, an unconditional rule with no stated exception for fetal viability or stage of pregnancy. This is a stricter, blanket exclusion, not one conditioned on whether the fetus could develop to live birth.

If an attending physician is unwilling to comply with a declaration under Section 459.015, or with the pregnancy rule under Section 459.025, the physician must take all reasonable steps to transfer the declarant to another physician. A health care facility whose policies preclude compliance must take all reasonable steps to transfer the declarant to a facility that will comply.

A physician, licensed health care professional, medical care facility, or employee who in good faith and per usual medical standards causes or participates in withholding or withdrawing death-prolonging procedures under a valid declaration is not subject to criminal or civil liability and is not found to have committed unprofessional conduct.

The federal Patient Self-Determination Act requires Medicare- and Medicaid-participating health care facilities to inform patients in writing of their right under Missouri law to make an advance directive, and to honor valid directives.

Federal HIPAA regulations govern how a designated health care agent or representative can be authorized to access protected health information in connection with your advance care planning documents.

Missouri's Revised Uniform Anatomical Gift Act (Sections 194.210 to 194.294) lets you state your organ and tissue donation wishes, which may be addressed alongside your declaration.

Missouri's 'death-prolonging procedure' definition, the thing a declaration can direct withholding or withdrawing of, expressly excludes medication or medical procedures deemed necessary to provide comfort, care, or to alleviate pain. Comfort and pain-relief care continues regardless of the life-sustaining treatment choices in your declaration.

Missouri's statute does not separately itemize CPR, mechanical ventilation, dialysis, or surgery. All of these fall under the single general definition of 'death-prolonging procedure' at Section 459.010: any medical procedure or intervention that would serve only to prolong the dying process. A declarant may still describe specific interventions in their own words, since the statutory sample form is optional and other specific directions are permitted.

Missouri's declaration and its Durable Power of Attorney for Health Care Act are two separate documents under two separate chapters, not two parts of one instrument. The declaration states your own treatment wishes directly and names no agent; the health care power of attorney names someone else to decide for you. A person can execute either alone or both together, and should note in each document how they relate if both are signed. For agent-designation guidance specifically, see Missouri Healthcare Power of Attorney.

Missouri's declaration cannot direct the withholding or withdrawal of nutrition or hydration at all. The statutory definition of 'death-prolonging procedure,' the only category of treatment a declaration can address, expressly excludes 'the performance of any procedure to provide nutrition or hydration.' This is a materially different, more restrictive posture than states that require ANH to be a separate initialed election; in Missouri it is outside the declaration's scope altogether.

Separate from the good-faith immunity provision (Section 459.040), Section 459.045 makes it unprofessional conduct for a physician or provider with actual knowledge of a declaration to act contrary to it, without serious reason, once the declarant is terminal and unable to decide. It also criminalizes concealing, destroying, or forging a declaration or a revocation of one: a class A misdemeanor for concealment or destruction without the declarant's consent, and a class B felony if done to cause a wrongful withholding or withdrawal that directly causes or hastens death.