Kentucky Healthcare Surrogate and Living Will for Adults with Disabilities

What Changes at 18 for Medical Decisions

The moment your child turns 18 in Kentucky, HIPAA protections kick in fully. Doctors, hospitals, and therapists can no longer share medical information with you or accept your instructions about treatment — unless your young adult has signed documents authorizing it. This catches many disability families off guard, especially those who have been managing complex medical needs for years.

Kentucky's solution is the Healthcare Surrogate Designation and Living Will Directive, governed by KRS 311.621 through 311.643. This is a single unified document that lets your young adult name a healthcare surrogate (the person who makes medical decisions when they cannot) and record their wishes about life-prolonging treatments.

How the Surrogate's Authority Works

The healthcare surrogate's power is not active the moment the document is signed. It activates only when the attending physician and one other examining physician certify in writing that the young adult lacks decisional capacity for a specific healthcare decision. If your son or daughter is having a good day and can communicate their preferences, the surrogate steps back — the young adult's own voice takes priority.

This is a crucial distinction from guardianship. A court-appointed guardian's authority is continuous once the order is entered. A healthcare surrogate's authority switches on and off based on real-time capacity — preserving the young adult's self-determination whenever they can exercise it.

Execution Requirements

The directive must be:

• Signed and dated by the principal (your young adult)
• Executed in the joint presence of two or more adult witnesses, or acknowledged before a notary public

Kentucky is strict about who cannot serve as a witness or notary:

• Blood relatives of the principal
• Anyone who would benefit from the principal's estate
• The attending physician
• Employees of a healthcare facility where the principal is currently a patient (unless the employee is acting solely as a notary)
• Anyone financially responsible for the principal's medical care

The capacity threshold for signing is lower than most families expect. Your young adult needs to understand the basic concept: "I am naming someone to help with my medical decisions if I cannot make them myself." They do not need to understand every clinical scenario the document might cover.

What the Surrogate Cannot Do

Kentucky law places hard limits on surrogate authority, even with a valid directive in place. A healthcare surrogate cannot authorize:

• Sterilization
• Psychosurgery or lobotomy
• Removal of a bodily organ (unless a specific court order exists or there is a life-threatening emergency)

These protections exist specifically because the surrogate's authority is exercised when the principal lacks capacity — the law builds in safeguards against the most consequential and irreversible medical interventions.

Healthcare Surrogate vs. Financial POA

The healthcare surrogate designation covers medical decisions only. It does not give the surrogate authority over bank accounts, government benefits, insurance claims, or any financial matter. For financial authority, Kentucky families use a separate durable power of attorney under KRS Chapter 457.

Most families execute both documents at the same time — often in the same notary appointment — so that the turning-18 transition is covered on both the medical and financial sides. The two instruments are legally independent, and the agents named in each can be different people if the family prefers.

When a Healthcare Surrogate Is Not Enough

If your young adult cannot understand what it means to designate a surrogate — even with communication supports and simplified explanations — the document may not be valid. In that case, medical decision-making authority may need to come through a limited or full guardianship order from the Kentucky District Court.

The guide walks through how to determine whether your young adult has enough capacity for private documents (POA and healthcare surrogate) or whether court-supervised guardianship is necessary. See our Kentucky Adult Guardianship & Alternatives Guide for the complete less-restrictive-first decision framework.

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