Health care directive in Missouri: form, signing and who decides
The form, who can witness, who can be your agent and who decides if you have no directive in Missouri.
Checked against official sources: October 31, 2026.
Short answer
Durable power of attorney for health care; separately, a declaration (living will)
- Official form
- Declaration
- How to sign
- Notarized
- Who decides without a directive
- No
The document and its form
- Document
- Durable power of attorney for health care; separately, a declaration (living will)
- Official form
- Declaration (sample living will form in RSMo 459.015.3)Published by Missouri Revisor of Statutes (official statute text; the sample form is printed in the section)Version: Statutory sample form, RSMo 459.015 (effective August 28, 1985)
You do not have to use it.
- Living will
Declaration
The living will is a separate document.
A competent adult can sign a declaration directing that death-prolonging procedures be withheld or withdrawn if they have a terminal condition and cannot make decisions. It must be in writing, signed (or signed for you in your presence at your direction) and dated; if not wholly in your handwriting, it must be signed in front of two or more witnesses age 18 or older, neither of whom signed for you. Death-prolonging procedures do not include comfort care or nutrition and hydration. You must make sure your doctor knows about it. It has no effect while you are pregnant.
Law: RSMo § 459.015.3; RSMo §§ 459.010, 459.015, 459.025
Signing rules
- How to sign
Sign and date the durable power of attorney for health care and have it acknowledged before a notary. A living will declaration has a different rule: if it is not entirely in your handwriting, sign it in front of two adult witnesses; a notary is not required for the declaration.
- Who signs
A durable power of attorney for health care must meet the same rules as a financial durable power of attorney: titled 'Durable Power of Attorney', with the durability statement, signed and dated by you.
- Notary
- Required
- Witnesses
- None required
- Nursing facilities and special settings
Your attending physician or their employee, or an owner, operator or employee of a health care facility where you live, cannot be your attorney in fact unless related to you within the second degree or a member of the same religious community.
Law: RSMo 404.815
Law: RSMo §§ 404.705, 404.810, 459.015
Who can be your agent and what the agent can do
- Who cannot be your agent
Your attending physician or their employee, or an owner, operator or employee of a health care facility where you live, cannot serve unless related to you within the second degree or a member of the same religious community. A person disqualified from being your guardian or conservator under RSMo 475.055.2 cannot be your attorney in fact under a durable power of attorney.
Law: RSMo 404.815; RSMo 404.707.2
- When the agent starts
Unless you expressly say otherwise, the attorney in fact's health care powers start when two licensed physicians (one may be your attending physician) certify after examining you that you are incapacitated and will remain so while decisions are needed, and stop when you are certified no longer incapacitated. At least one physician's certification is always required.
Law: RSMo 404.825
- Decisions an agent cannot make
The attorney in fact can direct withholding or withdrawal of artificially supplied nutrition and hydration only if you specifically granted that power in the document, and never food or water you can take by natural means with intent to cause death. The attorney in fact cannot delegate health care decisions unless you explicitly allowed it. Providers may refuse decisions contrary to religious or moral convictions but must not block a transfer.
Law: RSMo 404.820; RSMo 404.865; RSMo 404.830
Revoking and conflicting documents
- Revoking your agent
You can revoke a power of attorney for health care at any time and in any manner by which you can communicate your intent. It takes effect when you tell the attorney in fact, your attending physician or another health care provider. Signing a new valid health care power of attorney revokes earlier ones unless it says otherwise.
Law: RSMo 404.850
- Revoking your instructions
You can revoke a declaration at any time and in any manner you can communicate, regardless of your mental or physical condition.
Law: RSMo 459.020
- Telling others
A physician or provider who learns of a revocation must put it in your medical record. A person is not liable for failing to act on a declaration revocation unless it is in your record or they actually know of it.
Law: RSMo 404.850.2, 459.020.2; RSMo 459.020.3
- Divorce ends a spouse's authority
- Yes · Divorce rules in Missouri (Divorce Law Map)
- Conflicting documents
Unless the document says otherwise, signing a new valid power of attorney for health care revokes earlier ones. Your own current decisions always override your declaration.
Law: RSMo 404.850.3; RSMo 459.025
Law: RSMo §§ 404.717.1(6), 404.810, 404.850, 459.020
If you have no directive
- Who decides without a directive
Missouri's health care decision statutes do not set a general priority list of family members who may decide for an adult who has no durable power of attorney for health care and no guardian.
Other states, registry and medical orders
- Signed in another state
Missouri's definition of a durable power of attorney, which also applies to health care powers, includes one that is durable under the law of the place where it was signed, where you lived when you signed it, or a place named in it that has a reasonable relationship to it.
Law: RSMo 404.703(4), 404.805.2
Free notice: revoke or change a health care directive
Free help in Missouri
- Missouri Legal Services (statewide legal aid information site)
- Missouri Revisor of Statutes: Durable Power of Attorney Law (RSMo 404.700-404.735)
- Missouri Revisor of Statutes: Guardianship and conservatorship (RSMo Chapter 475)
- Find free legal aid at LawHelp.org
Report abuse or exploitation
Missouri Department of Health and Senior Services - Adult Abuse and Neglect Hotline · 1-800-392-0210
Questions about powers of attorney in Missouri
How do I sign a health care directive in Missouri?
Sign and date the durable power of attorney for health care and have it acknowledged before a notary. A living will declaration has a different rule: if it is not entirely in your handwriting, sign it in front of two adult witnesses; a notary is not required for the declaration.
Who decides my health care if I have no directive in Missouri?
Missouri's health care decision statutes do not set a general priority list of family members who may decide for an adult who has no durable power of attorney for health care and no guardian.