Advance Directive Kentucky: Living Will and Healthcare Surrogate Requirements

A Kentucky advance directive is actually two tools in one document. Under KRS 311.625, the statutory form combines a Living Will Directive (your parent's instructions about end-of-life treatment) with a Healthcare Surrogate Designation (naming someone to make medical decisions when they cannot).

Most families searching for this form are in one of two situations: a parent facing surgery and the hospital wants paperwork, or a parent showing early cognitive decline and the family realizes no one has legal authority to consent to treatment. Either way, the form itself is free and built into Kentucky statute, but the execution rules trip up more families than the drafting.

What the Form Actually Controls

The Living Will portion lets your parent state preferences on three categories of treatment if they become permanently unconscious or terminally ill:

• Life-prolonging procedures (mechanical ventilation, dialysis, cardiac resuscitation)
• Artificial nutrition (feeding tubes)
• Hydration (IV fluids)

Your parent can authorize all of these, refuse all of them, or set conditions. The form also includes a space for the healthcare surrogate designation, which names the person who will make all other medical decisions — facility admissions, medication changes, specialist referrals, discharge planning — when the parent cannot communicate.

One important limit: the Kentucky Supreme Court clarified in Lexington Alzheimer's Investors, LLC v. Norris (2025) that signing a nursing home's arbitration or alternative dispute resolution agreement is not a healthcare decision under the Act. A designated healthcare surrogate does not automatically have authority to bind a parent to arbitration upon facility admission.

How to Sign a Valid Advance Directive

Kentucky offers two execution paths — you need one, not both:

Option A: Notarization. Your parent signs the directive, and a notary public acknowledges the signature. No witnesses required.

Option B: Two adult witnesses. Your parent signs in the presence of two adults who also sign. The witnesses must be physically present with the parent and with each other at the time of signing.

If you use witnesses, Kentucky enforces strict disqualification rules under KRS 311.625(2). None of the following may serve as a witness:

• Blood relatives of the parent
• Anyone who would inherit under the parent's will or through intestate succession
• The parent's attending physician
• Employees of the healthcare facility where the parent is currently a patient (unless the employee is also serving as the notary)
• Anyone financially responsible for the parent's medical care

These exclusions are more aggressive than many states. The practical effect: you cannot ask a sibling, a spouse, or a hospital nurse to witness the document. Neighbors, friends, or colleagues who have no financial or familial relationship to the parent are the safest choice.

Advance Directive vs. MOST Form

Families sometimes confuse the advance directive with Kentucky's Medical Orders for Scope of Treatment (MOST) form. They serve different purposes:

The MOST form is not a replacement for the advance directive. It is a clinical tool for people already in advanced illness, creating binding medical orders that first responders honor in the field. Most families need the advance directive first and add a MOST form later if the parent's condition becomes terminal.

Common Mistakes That Invalidate the Document

Using a generic template from another state. Kentucky's statutory form under KRS 311.625 has specific language about healthcare surrogate designation that out-of-state forms miss. A Virginia or Ohio advance directive will not automatically be honored by Kentucky hospitals.

Having a relative witness. Even a well-meaning cousin counts as a blood relative under the statute. If challenged, the document fails.

Forgetting the pregnancy clause. Kentucky law automatically suspends an advance directive during pregnancy. If your parent is of childbearing age, the living will provisions are legally inoperative until the pregnancy concludes, regardless of what the form says.

Not distributing copies. A signed advance directive locked in a home safe does nothing when your parent arrives at the ER. Give copies to the designated healthcare surrogate, the parent's primary care physician, and any hospital or long-term care facility where the parent receives treatment.

When Medical Authority Is Not Enough

A healthcare surrogate designation handles medical decisions, but it gives zero authority over finances. If your parent also needs someone to manage bank accounts, pay bills, handle insurance claims, or apply for Medicaid, you need a separate Durable Power of Attorney under KRS Chapter 457.

The Kentucky Power of Attorney & Guardianship Kit covers both documents — the financial POA and the advance directive — along with the guardianship court process for families where capacity has already been lost. It includes filing checklists, the Wiley witness audit, and step-by-step instructions for each pathway.

See more Kentucky guides →