An Oklahoma advance directive is a form that allows a person to outline preferences for medical treatment and the administration of life-sustaining procedures. The form also authorizes a designated healthcare agent to carry out these stated wishes on behalf of the principal. It becomes useful in the event of mental incapacitation or the inability to make personal healthcare decisions.
Statutory Form
- Statute: § 63-3101.4
- Download: Adobe PDF
Advance Directive for Health Care
I, [NAME], being of sound mind and eighteen (18) years of age or older, willfully and voluntarily make known my desire, by my instructions to others through my living will, or by my appointment of a health care proxy, or both, that my life shall not be artificially prolonged under the circumstances set forth below. I thus do hereby declare:
If my attending physician and another physician determine that I am no longer able to make decisions regarding my medical treatment, I direct my attending physician and other health care providers, pursuant to the Oklahoma Rights of the Terminally Ill or Persistently Unconscious Act, to withhold or withdraw treatment from me under the circumstances I have indicated below by my signature. I understand that I will be given treatment that is necessary for my comfort or to alleviate my pain.
If I have a terminal condition:
(1) I direct that life-sustaining treatment shall be withheld or withdrawn if such treatment would only prolong my process of dying, and if my attending physician and another physician determine that I have an incurable and irreversible condition that even with the administration of life-sustaining treatment will cause my death within six (6) months.
Signed this [DAY] day of [MONTH], 20[XX].
___________________________________
(Signature)
(2) I understand that the subject of the artificial administration of nutrition and hydration (food and water) that will only prolong the process of dying from an incurable and irreversible condition is of particular importance. I understand that if I do not sign this paragraph, artificially administered nutrition and hydration will be administered to me. I further understand that if I sign this paragraph, I am authorizing the withholding or withdrawal of artificially administered nutrition (food) and hydration (water).
My Appointment of My Health Care Proxy
If my attending physician and another physician determine that I am no longer able to make decisions regarding my medical treatment, I direct my attending physician and other health care providers pursuant to the Oklahoma Rights of the Terminally Ill or Persistently Unconscious Act to follow the instructions of [NAME], whom I appoint as my health care proxy. If my health care proxy is unable or unwilling to serve, I appoint [NAME] as my alternate health care proxy with the same authority. My health care proxy is authorized to make whatever medical treatment decisions I could make if I were able, except that decisions regarding life-sustaining treatment can be made by my health care proxy or alternate health care proxy only as I indicate in the following sections.
Signed this [DAY] day of [MONTH], 20[XX].
___________________________________
(Signature)
This advance directive was signed in my presence.
___________________________________
(Signature of Witness)
[ADDRESS, STREET, CITY, STATE, ZIP CODE]
(Address)
___________________________________
(Signature of Witness)
[ADDRESS, STREET, CITY, STATE, ZIP CODE]
(Address)
Adobe PDF