Living will requirements in Missouri

Which document this is

Missouri’s living will has a name most people never hear until they need it: the Declaration, created by the Missouri Life Support Declarations Act. It is a written statement of the treatment you do and do not want if you are ever diagnosed with a terminal condition and cannot decide for yourself. Missouri keeps a second, entirely separate statute for naming someone to decide on your behalf: the Durable Power of Attorney for Health Care. The person you name in it is your attorney-in-fact, Missouri’s own term, not agent or proxy.

The two documents are not interchangeable, and Missouri gives them opposite signing rules rather than a shared one. The Declaration asks for witnesses and does not mention a notary anywhere in its text. The Durable Power of Attorney for Health Care asks for the opposite: it has to be signed and acknowledged before a notary, the same way Missouri law treats a real estate deed, and the statute that creates it does not ask for witnesses at all. Missouri also lets you write the Declaration entirely in your own handwriting, in which case it needs no witnesses either.

This is exactly the pairing Myend’s Healthcare Directive prepares for Missouri: a Declaration for your wishes, and a Durable Power of Attorney for Health Care for your attorney-in-fact, each signed the way its own statute requires.

Who can make a Missouri living will

Missouri asks you to be a “competent person”: 18 years of age or older, of sound mind, and able to receive and evaluate information and communicate a decision. That is the standard the statute itself sets, and the Declaration’s own printed form repeats the same 18-or-older line in its witness attestation.

The Durable Power of Attorney for Health Care does not restate a specific numeric age requirement in the sections that govern how it is signed. In practice you sign it as an adult with the capacity to understand what you are doing, the general standard Missouri applies to a power of attorney for any purpose.

Signing it so it counts

Missouri runs two separate signing rules, one for each document, and they point in opposite directions. Do not borrow one for the other: the Declaration does not accept a notary in place of witnesses, and the Durable Power of Attorney for Health Care does not accept witnesses in place of a notary.

The Declaration

1. 1You sign

   You sign and date the Declaration yourself, or direct someone else to sign it on your behalf and in your presence if you are physically unable to sign it.

2. 2Two witnesses, unless it is handwritten

   If the Declaration is not wholly in your own handwriting, you sign it in front of two witnesses, each at least 18 years old. If you write out the entire Declaration yourself, in your own hand, Missouri does not require any witness at all.

3. 3Who cannot witness

   The only person Missouri’s statute disqualifies as a witness is whoever signed the Declaration on your behalf and at your direction, if you were physically unable to sign it yourself. Section 459.015 names no other category, and it asks only that each witness be at least 18. That is a short list by any state’s standard, and it is worth knowing what it does not do: it does not tell you a relative or a beneficiary is a good choice, only that Missouri’s own statute does not stop you.

The Durable Power of Attorney for Health Care

Naming your attorney-in-fact is a separate signing, on its own paper, and Missouri asks for the opposite formality. The statute requires the power of attorney to be subscribed by you, dated, and acknowledged in the manner prescribed by law for conveyances of real estate, the same acknowledgment Missouri requires to transfer real property. That means a notary public, not witnesses. The section that creates the Durable Power of Attorney for Health Care does not mention witnesses at all.

Naming your attorney-in-fact

The Durable Power of Attorney for Health Care is where you name your attorney-in-fact, Missouri’s own term for the person who makes health care decisions for you once the document takes effect. Missouri’s disqualification list is narrow. Your attending physician, or an employee of your attending physician, cannot serve, and neither can the owner, operator, or an employee of the health care facility where you live, unless one of two exceptions applies: you and that person are related by blood or marriage within the second degree, or you and that person belong to the same religious community, bound by vows to a religious life, that conducts or assists in conducting religious services and regularly carries out religious, benevolent, charitable, or educational ministry or health care services.

One more rule reaches this document from Missouri’s general power of attorney law, which section 404.810 applies to health care powers: under section 404.707 your attorney-in-fact has to be someone who would not be disqualified from serving as your guardian or conservator under section 475.055. That rules out anyone under 18 and anyone who is themselves incapacitated or disabled, and it reaches an administrator, owner, operator, manager or employee of a facility licensed by Missouri’s mental health or social services department where you are a resident, unless that person is related to you within the fourth degree.

Within those limits, once your Durable Power of Attorney for Health Care takes effect, your attorney-in-fact steps into the health care decisions you would otherwise make for yourself.

When it takes effect

Your own current, expressed wishes always control, whatever your Declaration says. The Declaration itself only becomes operative once two things are both true and both recorded in your medical record: a physician has determined that your condition is terminal, and you are no longer able to make your own treatment decisions. A provider is not allowed to act against your clearly expressed wishes to withhold or withdraw treatment without a serious, documented reason consistent with your best interest.

The Durable Power of Attorney for Health Care runs on its own trigger, in section 404.825. Unless you say otherwise in the document itself, your attorney-in-fact’s powers begin on a certification by two licensed physicians, based on an examination, that you are incapacitated and will stay incapacitated for as long as treatment decisions are needed, and they end on a certification that you are no longer incapacitated. One of the two may be your attending physician, the certification goes into your medical record with the facts behind it, and your attending physician reviews the finding periodically.

If you are pregnant

Once your attending physician has diagnosed you as pregnant, Missouri law sets your Declaration aside for the rest of the pregnancy. Section 459.025 puts it in one sentence, and that sentence carries no other condition. It does not turn on how many weeks along you are, there is no viability test, and it runs for the whole pregnancy rather than part of it. The exact wording is in the sources list below.

Changing or cancelling it

You can revoke your Declaration at any time and in any manner that shows your intent to revoke it, no matter your mental or physical condition. Once your attending physician or another provider learns of the revocation, they have to add it to your medical record. Nobody is liable for failing to honor a revocation they did not actually know about.

The Durable Power of Attorney for Health Care has its own revocation section, and it is just as open. Section 404.850 lets you revoke it at any time and in any manner by which you can communicate the intent, and the revocation takes effect once you communicate it to your attorney-in-fact, your attending physician, or another health care provider, who then has to put it in your medical record. Signing a new valid health care power of attorney also revokes the earlier one, unless the new document says otherwise.

Making sure it is found

Missouri does not appear to run a state registry for either document; neither the Life Support Declarations Act nor the Durable Power of Attorney for Health Care Act sets one up. That makes copies your real safeguard: give one of each to your attorney-in-fact, your physician, and the hospital you are most likely to use, and keep the signed originals somewhere your family knows to look.

A Declaration nobody can find works the same as no Declaration at all. The most common failure is not a missing signature, it is paperwork sitting in a drawer at home while a decision is being made in an emergency room. Naming your attorney-in-fact, then telling them plainly where both documents live, closes most of that gap.

This is not a POLST

A POLST-style medical order is a different kind of document from either your Declaration or your Durable Power of Attorney for Health Care. This page uses the general term rather than a Missouri program name, because Missouri’s own name for it is not settled on a source solid enough to print. A clinician signs it together with someone who is already facing serious illness, and it becomes a set of standing medical orders meant to travel with that person between hospital, nursing facility, home and ambulance. A Declaration and a Durable Power of Attorney for Health Care, by contrast, are something you put in place in advance, for a future you cannot yet see. Myend prepares the Declaration and the Durable Power of Attorney for Health Care. It does not, and cannot, produce a POLST-style medical order, because that has to come from a treating clinician.

What is different about Missouri

Missouri hands you two documents, then gives them opposite signing rules: witnesses for the one that carries your wishes, a notary for the one that names your attorney-in-fact.

Most two-document states offer the same choice on both papers, witnesses or a notary, take your pick. Missouri does not. The Declaration is witnesses-only, unless you write the whole thing in your own hand, in which case it needs no witness at all. The Durable Power of Attorney for Health Care is notary-only, and its statute never mentions a witness. Sign the wrong document the wrong way, or assume one document’s rule covers the other, and it will not hold up.

Missouri also draws its attorney-in-fact restriction more narrowly than most states, and more specifically. A physician, a physician’s employee, or a facility owner, operator or employee is barred from serving, unless that person is related to you within the second degree, or belongs to the same religious community as you. Missouri writes that exception directly into the statute, rather than leaving the restriction as a flat bar.

And the pregnancy rule leaves no room to negotiate. Once your attending physician has diagnosed you as pregnant, your Declaration is set aside for the rest of the pregnancy, with no viability test and no second opinion required to trigger it.

Common questions

Sources and review