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Advance Directives

Living Will & Durable Power of Attorney Forms

Note: Scott County Hospital makes these forms available, but patients are welcome to use Advance Directive forms from other sources.

Scott County Hospital respects your right to make your own medical treatment decisions. In order to help you exercise this right, we offer the following information:

What are "Advance Directives"?

Advance Directives are documents that state a patient's choice about treatment including decisions like refusing treatment, being placed on life-support, and stopping treatment at a point the patient chooses. It also includes requesting life-sustaining treatment if that is wanted.

Right to Choose

Medical treatment decisions are a matter of personal choice. We are committed to providing each patient or patient's legal representative with the information he or she needs to understand and consider the options available under state law, but the decision whether or not to act is always up to you.

Compliance with State Law

We will ensure that we are in compliance with the requirements of state law, whether statutory or as set forth in applicable court cases, on the subject of informed consent to medical treatment and the formulation of Advance Directives by our patients.


Adult individuals and emancipated minors have the right to make decisions concerning their care, including the right to accept or refuse medical or surgical treatment and the right to formulate, at the individual's option, Advance Directives as permitted under state statutory and case law.

Adult individuals and emancipated minors also have the right to have hospital staff implement and comply with their Advance Directives.

Advance Directives are written instructions, recognized under State law, relating to the provision of health care when the individual is incapacitated. A person can implement an Advance Directive only for themselves; not another person. Advance Directives recognized by Kansas statutes include a Living Will and a Durable Power of Attorney for Health Care.

A Living Will states that life-sustaining procedures should be withheld or withdrawn when decision making capacity is lost and when such procedures would merely prolong death. Medical procedures deemed necessary to provide comfort or "alleviate pain" are not considered "life-sustaining procedures." A Living Will doesn't not take effect until two physicians have certified the patient is terminally ill. A Living Will is not effective during pregnancy.

A Durable Power of Attorney for Health Care is a document in which an individual gives someone else the right to make decisions about health care for him/her. A Durable Power of Attorney for Health Care does not go into effect until the individual can no longer receive and evaluate information effectively or communicate their decisions as determined by their physician. The Durable Power of Attorney for Health Care can be used with caution during pregnancy, provided decisions do not adversely affect the viability of the fetus. Kansas does not currently have a specific statute for a Psychiatric Advance Directive, however a Durable Power of Attorney for Health Care can be written to authorize the agent to make decisions about mental health as well, therefore you are encouraged to discuss your wishes regarding psychiatric treatment with your chosen agent(s).

A physician who is unwilling to comply with an individual's Advance Directive, due to personal beliefs or values, will make arrangements for transfer of care to another physician, pursuant to K.S.A. 65-28, 107.

All adults or emancipated minors who are admitted to any level of care at Scott County Hospital will be given this written notice of Scott County Hospital Advance Directives Policies, including where to file complaints concerning Advance Directive requirements. If the individual is incapacitated or otherwise unable to communicate, the next of kin will be provided with this information.


We will document in your medical record whether or not you have executed an Advance Directive. We will request a copy of your directive to guide health care decisions. Although we will provide information we hope will be helpful to many patients in understanding their options, we are not permitted to give either medical or legal advice. Such consultation, if needed or desired, should be sought from a qualified lawyer or physician.

No Discrimination

Whether or not a patient chooses to execute an Advance Directive is a personal matter and will never be a condition of providing care or a basis for discrimination against you.


We provide or participate in providing education for staff and community on issues relating to Advance Directives.


Medical treatment decisions sometimes raise difficult issues for patients, family members, and the care team to deal with. We are committed to discussing and resolving these questions as they arise. If you have questions or are unsure about our policies, please ask for further clarification.

If you have any questions, concerns or complaints about Advance Directives requirements, you may do any of the following:

Contact your nurse and/or ask for Social Services.
Fill out a grievance form. Grievance forms are available at the nurses' station, at the front desk, or from the Scott County Hospital Risk Manager/Quality Improvement Coordinator.
Contact the Scott County Hospital Risk Manager/Quality Improvement Coordinator at (620) 872-7753.
Call KDHE - Kansas Department of Health and Environment at 1-800-842-0078.