65-28,103. Same; declaration authorizing; effect during pregnancy of qualified patient; duty to notify attending physician; form of declaration; severability of directions. (a) Any adult person may execute a declaration directing the withholding or withdrawal of life-sustaining procedures in a terminal condition. The declaration made pursuant to this act 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)(A) signed in the presence of two or more witnesses at least 18 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, related to the declarant by blood or marriage, entitled to any portion of the estate of the declarant according to the laws of intestate succession of this state or under any will of the declarant or codicil thereto, or directly financially responsible for declarant's medical care; or (B) acknowledged before a notary public. The declaration of a qualified patient diagnosed as pregnant by the attending physician shall have no effect during the course of the qualified patient's pregnancy.
(b) It shall be the responsibility of declarant to provide for notification to the declarant's attending physician of the existence of the declaration. An attending physician who is so notified shall make the declaration, or a copy of the declaration, a part of the declarant's medical records.
(c) The declaration shall be substantially in the following form, but in addition 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 direction, and to this end the directions in the declaration are severable.
DECLARATION
Declaration made this ___________ day of ______ (month, year). I, _____________, being of sound mind, willfully and voluntarily make known my desire that my dying shall not be artificially prolonged under the circumstances set forth below, do hereby declare:
If at any time I should have an incurable injury, disease, or illness certified to be a terminal condition by two physicians who have personally examined me, one of whom shall be my attending physician, and the physicians have determined that my death will occur whether or not life-sustaining procedures are utilized and where the application of life-sustaining procedures would serve only to artificially prolong the dying process, I direct that such procedures be withheld or withdrawn, and that I be permitted to die naturally with only the administration of medication or the performance of any medical procedure deemed necessary to provide me with comfort care.
In the absence of my ability to give directions regarding the use of such life-sustaining procedures, it is my intention that this declaration shall be honored by my family and physician(s) as the final expression of my legal right to refuse medical or surgical treatment and accept the consequences from such refusal.
I understand the full import of this declaration and I am emotionally and mentally competent to make this declaration.
Signed ____________________________________
City, County and State
of Residence ______________________________
The declarant has been personally known to me and I believe the declarant to be of sound mind. I did not sign the declarant's signature above for or at the direction of the declarant. I am not related to the declarant by blood or marriage, entitled to any portion of the estate of the declarant according to the laws of intestate succession or under any will of declarant or codicil thereto, or directly financially responsible for declarant's medical care.
Witness ___________________________________________ Witness ___________________________________________
(OR)
STATE OF ____________________)
______________________________ ss.
COUNTY OF ____________________)
This instrument was acknowledged before me on ________ (date) by ______________________ (name of person)
____________________________________________________
(Signature of notary public)
(Seal, if any)
My appointment expires: ________________________
Copies
History: L. 1979, ch. 199, § 3; L. 1994, ch. 224, § 2; July 1.
Structure Kansas Statutes
65-2803 Prerequisite to practice a profession regulated by the board; exceptions; penalties.
65-2804 Attainment of legal age required prior to receiving permanent license.
65-2806 Form and type of license.
65-2807 License presumptive evidence of right to practice.
65-2811 Issuance of temporary permits; postgraduate permits.
65-2812 State board of healing arts; membership; appointment.
65-2813 State board of healing arts; qualifications of members.
65-2814 Same; terms of members; vacancies.
65-2817 Same; removal from office by governor, when.
65-2819 Same; seal; rules; oath; meetings.
65-2823 Same; compensation and expenses of members.
65-2824 Application for examination, contests; fees; documents and affidavits.
65-2825 Accredited schools; list.
65-2826 Where and when examinations held.
65-2827 List of eligible applicants prior to examinations.
65-2828 Rules and regulations designating examinations and passing grade; reexamination.
65-2831 Issuance of license; record.
65-2832 Preservation of examination results; availability.
65-2833 Endorsement licenses; requirements; rules and regulations.
65-2835 Certificate of standing; application; fee.
65-2838a Non-disciplinary resolution; procedure.
65-2840c Review committees; establishment; composition; expenses.
65-2846 Costs of proceedings; assessment of costs incurred.
65-2847 Same; costs due state; uncollectible, paid by board.
65-2849 Hearing of cause in district court; precedence.
65-2850 Same; appeal bond of licensee.
65-2851a Administrative proceedings; procedure, review and civil enforcement.
65-2852 Fees; collection by board.
65-2855 Fees; disposition of; healing arts fee fund.
65-2857 Injunction and quo warranto for unlawful practice of the healing arts.
65-2858 Same; authority conferred by 65-2857 additional to authority to prosecute criminally.
65-2859 Filing false documents with board; forgery; penalty.
65-2860 False impersonation; fraud; penalty.
65-2861 False swearing; penalty.
65-2862 Penalties for violations of act; second conviction.
65-2863a Administrative fines.
65-2864 Enforcement of act; investigations; evidence.
65-2865 Rules and regulations; filing.
65-2867 Certain acts prohibited; exceptions; penalties.
65-2869 Persons deemed engaged in practice of medicine and surgery.
65-2870 Persons deemed engaged in practice of osteopathy.
65-2871 Persons deemed engaged in practice of chiropractic.
65-2872 Persons not engaged in the practice of the healing arts.
65-2872b Same; administration of epinephrine; limitation of liability.
65-2873a Board authorized to grant license in particular circumstances; exceptions; requirements.
65-2873b Resident active license; requirements.
65-2875 Accredited schools of osteopathic medicine defined.
65-2876 Accredited school or college of chiropractic, defined.
65-2880 Pending actions; vested rights saved.
65-2881 Current licenses continued; renewal.
65-2885 Use of title by licensee.
65-2886 Licensee to comply with public health laws and regulations.
65-2887 Assisting unlicensed persons to practice optometry not authorized; exceptions.
65-2890 Name of act; citation.
65-2890a Provisions of act applicable to any regulated profession.
65-2891 Emergency care by healthcare providers; liability; standards of care applicable.
65-2891b Emergency care by non-health care providers; liability, standards of care applicable.
65-2892 Examination and treatment of persons under 18 for venereal disease; liability.
65-2892a Examination and treatment of minors for drug abuse, misuse or addiction; liability.
65-2893 Autopsies; performance of; authorization.
65-2895 Institutional license; qualifications; rights and restrictions; term of license.
65-2898a Confidentiality of complaints and reports relating thereto; disclosure, when.
65-28,104 Same; revocation of declaration.
65-28,108 Same; construction and effect of act.
65-28,121 Reports by hospitals and others; administrative fines for failure to report.
65-28,123 Temporary education license; issuance; qualifications; conditions; fee.
65-28,126 Changes in licensee's mailing and practice addresses; notice to board; penalties.
65-28,129 State board of healing arts; fingerprinting and criminal history.
65-28,130 Same; graduated sanctions; reference guide.
65-28,131 Same; website; licensee information.