# K.S.A. § 65-28,103: 65-28,103 - Same; declaration authorizing; effect during pregnancy of qualified patient; duty to notify attending physician; form of declaration; severability of directions > Kansas · Statutes · In force URL: https://www.frixlaw.com/law-library/statutes/STATE_KS_C65_A28_S65-28%2C103 ## Section - **Citation:** K.S.A. § 65-28,103 - **Heading:** 65-28,103 - Same; declaration authorizing; effect during pregnancy of qualified patient; duty to notify attending physician; form of declaration; severability of directions - **Jurisdiction:** Kansas - **Kind:** Statutes - **Status:** In force - **Text as of:** August 14, 2026 - **Source:** Compiled text - **Location:** KS Code / Chapter 65 / Article 28 / Section 65-28,103 ## Text 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) 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 ## Nearby sections - [K.S.A. § 65-28,100 65-28,100 - Temporary license for visiting professor; designation; qualifications; application; rights conferred; validity of license; section supplemental.](https://www.frixlaw.com/law-library/statutes/STATE_KS_C65_A28_S65-28%2C100.md) - [K.S.A. § 65-28,101 65-28,101 - Withholding or withdrawal of life-sustaining procedures; legislative finding and declaration.](https://www.frixlaw.com/law-library/statutes/STATE_KS_C65_A28_S65-28%2C101.md) - [K.S.A. § 65-28,102 65-28,102 - Same; definitions.](https://www.frixlaw.com/law-library/statutes/STATE_KS_C65_A28_S65-28%2C102.md) - [K.S.A. § 65-28,103 65-28,103 - Same; declaration authorizing; effect during pregnancy of qualified patient; duty to notify attending physician; form of declaration; severability of directions.](https://www.frixlaw.com/law-library/statutes/STATE_KS_C65_A28_S65-28%2C103.md) - [K.S.A. § 65-28,104 65-28,104 - Same; revocation of declaration.](https://www.frixlaw.com/law-library/statutes/STATE_KS_C65_A28_S65-28%2C104.md) - [K.S.A. § 65-28,105 65-28,105 - Same; written certification and confirmation of declarant's terminal condition; effect of failure to comply.](https://www.frixlaw.com/law-library/statutes/STATE_KS_C65_A28_S65-28%2C105.md) - [K.S.A. § 65-28,106 65-28,106 - Same; desires of qualified patient supersede declaration; presumptions relating to declaration; immunity from civil or criminal liability for persons acting pursuant to declaration.](https://www.frixlaw.com/law-library/statutes/STATE_KS_C65_A28_S65-28%2C106.md) - [K.S.A. § 65-28,107 65-28,107 - Same; attending physician's refusal to comply with declaration of qualified patient; transfer of patient; unprofessional conduct; unlawful acts.](https://www.frixlaw.com/law-library/statutes/STATE_KS_C65_A28_S65-28%2C107.md) - [K.S.A. § 65-28,108 65-28,108 - Same; construction and effect of act.](https://www.frixlaw.com/law-library/statutes/STATE_KS_C65_A28_S65-28%2C108.md) - [K.S.A. § 65-28,109 65-28,109 - Same; act not to be construed to condone or approve mercy killing or to permit other than natural process of dying.](https://www.frixlaw.com/law-library/statutes/STATE_KS_C65_A28_S65-28%2C109.md) - [K.S.A. § 65-28,121 65-28,121 - Reports by hospitals and others; administrative fines for failure to report.](https://www.frixlaw.com/law-library/statutes/STATE_KS_C65_A28_S65-28%2C121.md) - [K.S.A. § 65-28,122 65-28,122 - Person licensed, registered or certified to practice a profession regulated by the board required to report knowledge of violation of K.S.A. 65-2836 to state board of healing arts; exceptions.](https://www.frixlaw.com/law-library/statutes/STATE_KS_C65_A28_S65-28%2C122.md) - [K.S.A. § 65-28,123 65-28,123 - Temporary education license; issuance; qualifications; conditions; fee.](https://www.frixlaw.com/law-library/statutes/STATE_KS_C65_A28_S65-28%2C123.md) - [K.S.A. § 65-28,124 65-28,124 - Visiting clinical professor license; issuance; qualifications; practice limitations; renewal; continuing education.](https://www.frixlaw.com/law-library/statutes/STATE_KS_C65_A28_S65-28%2C124.md) --- Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/STATE_KS_C65_A28_S65-28%2C103. Check the current official text before relying on it. Not legal advice.