Updated June 01, 2022
A Missouri living will is made by a person (“declarant”) that states they would rather not prolong the dying process if they should be permanently incapacitated. This is often caused by a stroke or other injury that leaves a person with no realistic chance of being cured. Rather than live with breathing and feeding assistance, the declarant chooses to withdraw life-supporting treatments.
Laws
- Signing Requirements – Two (2) witnesses (459.015(4)).
- Statutes – Chapter 459 (Declarations, Life Support)
How to Write
Download: Adobe PDF
Step 1 – Declaration of Declarant/Principal – The Declarant must review the information at the top of the form. If in agreement enter the following:
- Date the document in dd/mm/yyyy format
- Printed name of the Declarant
- Signature of the Declarant
- Complete physical address of the Declarant
Step 2 – Witnesses – There must be two witnesses to acknowledge the document. Both must read the brief statement. If in agreement, enter the following:
- Signature of witness
- Printed name
- Complete physical address
Step 3 – Revocation Provision – Should the Declarant decide against the living will they have created and are of sound mind, it may revoked at any time by providing the following information:
- Printed name of Declarant
- Signature of Declarant
- Date of signature in mm/dd/yyyy format
Step 4 – Missouri Durable Power of Attorney for Healthcare – Enter the following:
- Name of Principal/Declarant
- Complete address of Principal
- Full name of Attorney in Fact
- Complete address of Attorney in Fact
- Home telephone number
- Work telephone number
- Name of Alternate Attorney in Fact
- Complete address of Attorney in Fact
- Home Phone number
- Work Phone number
Step 5 – Acknowledgement of Principal – Read the statement. If in agreement:
- Enter the name of the Principal
- Date of the document in dd/mm/yyyy format
- Signature of the Principal
Step 6 – Notarization – Once the notary has witnessed all signatures, they will acknowledge by completing the remainder of the form as required by Missouri law and authenticating with the state seal.