Rhode Island Living Will Requirements

Introduction

Key Things to Know

1. 1

   Rhode Island's declaration form asks you to make two separate decisions, not one: a general instruction about withholding or withdrawing life-prolonging procedures, and then a distinct checkbox addressing artificial feeding on its own. This is your living will, Rhode Island's written statement of the medical treatment you want if you cannot speak for yourself; it does not name anyone to decide for you.

2. 2

   A living will is not a last will and testament. Your Rhode Island declaration governs medical treatment while you are alive but unable to communicate, while a last will and testament governs who inherits your property after you die.

3. 3

   Rhode Island does not combine the living will and the health care power of attorney into one document. The declaration (Chapter 23-4.11) and the Health Care Power of Attorney (Chapter 23-4.10) are separate statutes with separate execution rules, so signing one does not create or satisfy the other.

4. 4

   Rhode Island recognizes only one trigger condition for the declaration: a terminal condition, an incurable or irreversible condition that will, in your attending physician's opinion, result in death. There is no separate category here for permanent unconsciousness.

5. 5

   Two witnesses must sign your declaration, and Rhode Island's only disqualification is that a witness cannot be related to you by blood or marriage. There is no notary alternative for this document, a real contrast with the state's Health Care Power of Attorney.

6. 6

   If your attending physician knows you are pregnant, your declaration carries no force or effect for as long as it remains probable that the fetus could develop to live birth with continued treatment.

7. 7

   You may revoke your declaration at any time and in any manner that communicates your intent to revoke, regardless of your mental or physical condition. The revocation only takes effect once your physician or provider actually learns of it.

8. 8

   Rhode Island runs no state advance directive registry. Keep your signed original and hand copies directly to your physician, your family, and anyone named under a separate Health Care Power of Attorney.

9. 9

   Rhode Island is among a small number of states with no default family decision-maker law. Without a declaration or a Health Care Power of Attorney on file, there may be no automatic family member authorized to decide for you, and a court proceeding could become necessary.

Rhode Island Requirements for Living Will

• Rhode Island Statutory Authority (R.I. Gen. Laws Section 23-4.11-1 et seq.)

  The living will, called a declaration under Rhode Island law, must comply with the Rights of the Terminally Ill Act, General Laws Chapter 23-4.11, Rhode Island's legal framework for this document. This statute is entirely separate from Chapter 23-4.10, the state's Health Care Power of Attorney statute.

• Declaration Requirements (R.I. Gen. Laws Section 23-4.11-3)

  The declaration must be in writing, signed by the declarant, or by another person at the declarant's direction and in the declarant's presence, and witnessed by two adult witnesses. Rhode Island provides no notary alternative for this document; two-witness signing is the only path to a valid declaration, a real contrast with the state's separate Health Care Power of Attorney, which does allow a notary in place of witnesses.

• Witness Qualifications (R.I. Gen. Laws Section 23-4.11-3)

  Rhode Island's only witness disqualification for a declaration is being related to the declarant by blood or marriage. The statute does not exclude the declarant's health care provider, an employee of a health care provider, or anyone entitled to the declarant's estate from serving as a witness on this document; those exclusions exist only in Rhode Island's separate Health Care Power of Attorney statute, Section 23-4.10-2, not in the declaration statute.

• Terminal Condition Definition (R.I. Gen. Laws Section 23-4.11-2)

  The declaration addresses decisions relating to a terminal condition, defined as an incurable or irreversible condition that, without life sustaining procedures, will, in the attending physician's opinion, result in death. The statutory definition does not include a fixed timeframe such as death within a relatively short period.

• Revocation Provisions (R.I. Gen. Laws Section 23-4.11-4)

  A declarant may revoke the declaration at any time and in any manner that communicates an intent to revoke, regardless of mental or physical condition, though the revocation only becomes effective toward a specific physician or provider once communicated to them. If the same person has also signed a Rhode Island Health Care Power of Attorney and its terms conflict with the declaration, the later-executed document controls.

• Pregnancy Limitations (R.I. Gen. Laws Section 23-4.11-6)

  Rhode Island law gives a declaration no force or effect for a patient known by the attending physician to be pregnant, for as long as it remains probable the fetus could develop to the point of live birth with continued life sustaining procedures. The statute contains no separate exception for treatment that would cause physical harm to the pregnant patient.

• Physician Transfer Obligation (R.I. Gen. Laws Section 23-4.11-7)

  An attending physician or health care provider who will not comply with a declaration must arrange for the qualified patient's transfer to another physician who will honor it.

• Artificial Feeding Election (R.I. Gen. Laws Section 23-4.11-3(d))

  Rhode Island's optional statutory declaration form requires artificial feeding to be addressed as its own separate, specifically checked election, distinct from the general life sustaining treatment instruction. Marking the general choice does not answer the artificial-feeding question on its own.

• Comfort and Pain Relief Care (R.I. Gen. Laws Section 23-4.11-6(b))

  Nothing in Rhode Island's Rights of the Terminally Ill Act prohibits any action an attending physician considers necessary for comfort and care or to alleviate pain, regardless of the declaration's life sustaining treatment terms.

• Immunities for Compliance (R.I. Gen. Laws Section 23-4.11-8)

  Physicians, health care providers, and emergency medical services personnel who act in accordance with a declaration are not subject to civil or criminal liability, so long as they have no actual notice that the declaration has been revoked. The statute's standard is absence of actual notice of revocation, not a general good-faith standard.

• Patient Self-Determination Act Compliance (42 U.S.C. Section 1395cc(f))

  Federal law requires Medicare and Medicaid participating hospitals, nursing homes, and other facilities to inform patients in writing of their right under Rhode Island law to make a declaration stating their own treatment wishes.

• HIPAA Authorization (45 CFR Section 164.508)

  Federal HIPAA regulations govern how a designated health care agent can be authorized to access protected health information. Because Rhode Island keeps the declaration and the Health Care Power of Attorney as separate documents, this authorization matters to the agent named under the separate Rhode Island Healthcare Power of Attorney, not to the declaration itself, which names no agent.

• Organ Donation Wishes (R.I. Gen. Laws Section 23-18.6.1 et seq.)

  Rhode Island's Revised Uniform Anatomical Gift Act lets a person authorize organ and tissue donation, a separate legal mechanism from the treatment-wishes declaration covered on this page.

• Out-of-State Recognition (R.I. Gen. Laws Section 23-4.11-12)

  A declaration executed in another state is recognized as validly executed in Rhode Island so long as it complied with that other state's own law at the time it was signed. The statute requires compliance with the executing state's law, not merely a lesser 'substantial' compliance standard.

• No Default Family Surrogate Law (Rhode Island has no statutory equivalent)

  Rhode Island is among a small number of states, along with other states such as Massachusetts, Minnesota, Missouri, Nebraska, New Hampshire, and Vermont, with no statutory default-surrogate-consent law naming which family member may automatically make health care decisions for an incapacitated patient who has neither a declaration nor a Health Care Power of Attorney on file. Without one of those documents, decision-making authority may require a court-supervised guardianship proceeding rather than an automatic family designation.