Advance Directives

Health Care Decision Making

Advance directives are legal documents that allow you to describe wishes for treatment in the event that you are not able to make them for yourself. These decisions can foregoing life-support and stopping treatment.

Advance Directive Forms

• Durable Power of Attorney for Health Care Decisions (PDF)
• Durable Power of Attorney for Health Care Decisions (PDF, Spanish)
• Statutory Declaration of Right to Die (PDF)
• Statutory Declaration of Right to Die (PDF, Spanish)
• Common Law Living Will (PDF)
• Common Law Living Will (PDF, Spanish)

Durable Power of Attorney for Health Care Decisions

A Durable Power of Attorney for Health Care Decisions is a written document in which you authorize someone else to make health care decisions for you when you cannot make them yourself. The power of attorney is not limited to just life-sustaining procedures in the event of a terminal condition but also allows your agent to make other decisions in accordance with your wishes.

The power of attorney is effective immediately and is intended to allow you to avoid the necessity of having a court-appointed guardian to make health care decisions for you if you cannot make them yourself.

Statutory Declaration of Right to Die

The Statutory Declaration of Right to Die is a written statement based on the Kansas Natural Death Act. The Declaration covers the situation in which you have a “terminal condition” certified by two physicians. In this situation, you would ask that “life-sustaining procedures” be withheld with only medication being given to provide comfort.

Common Law Living Will

The Common Law Living Will not only covers a “terminal condition” but also substantial brain injury, irreversible coma, or extreme mental deterioration that cannot be reversed. In these situations, it describes your wishes regarding which medical procedures should be performed. You can specifically request that the following procedures not be conducted: surgery, dialysis, heart-lung resuscitation (CPR), antibiotics, mechanical ventilator (respirator), and tube feeding.

Advance Directives Policy

North Central Kansas Medical Center honors legally completed advance directives. If your physician or NCKMed cannot carry out your wishes, your care will be transferred to another physician or hospital that is able to follow your instructions.

You are responsible for making copies of your advance directives available to your physicians and North Central Kansas Medical Center. You should also consider discussing and sharing copies of your advance directives with your family members.