Medical power of attorney in Missouri: how it works, how to sign

Updated 2026-10-18

The short answer

Missouri has no general law letting a spouse, child or friend make medical decisions for an adult who can't. A durable power of attorney for health care fills that gap. You sign and date it before a notary; no witnesses are needed. A separate living will needs two witnesses instead.

The question under every medical power of attorney is a simple one. If you can't speak for yourself, who talks to the doctor?

In Missouri, that question has an unusual answer, and it makes this document more important here than in most states. This page covers what Missouri calls the document, how to sign it, how the living will fits in, and what happens if you name nobody. It is part of our estate planning guides for each state. For the basics of the role, see what a medical power of attorney is.

Who decides if I haven't named anyone?

Here is the plain answer: Missouri has no general default decision-maker law for adults. Most states have a law that lists which relatives can decide for you if you haven't named anyone, usually starting with a spouse. Missouri is one of a handful with no general list.

Missouri's consent law lets an adult consent for herself, and a court-appointed guardian consent for a ward (RSMo 431.061). It gives a spouse, an adult child or anyone else no general authority to decide for an adult who can't.

There is one narrow list. For an experimental treatment, test or drug at an accredited teaching hospital, consent can come from a guardian, an agent, or a family member in this order (RSMo 431.064):

Order	Who can consent (experimental treatment at a teaching hospital only)
1	Your spouse, unless separated, unable, unreachable or overseas
2	An adult child
3	A parent
4	A brother or sister
5	Another relative by blood or marriage

A close friend is not on that list, or any other. For everyday hospital decisions, without a health care agent the practical routes are guardianship or a court consent procedure.

That is why the document on this page matters so much in Missouri. Naming someone is how you choose who speaks for you. Our page on who decides for you walks through this in a few questions, and the 50-state guide to default decision-makers shows how Missouri compares.

What is the document called?

Missouri calls it a "durable power of attorney for health care," under the Durable Power of Attorney for Health Care Act (RSMo 404.800). The act has no official form, so a lawyer's draft or a well-written document works.

How do I sign one in Missouri?

The same rule that governs Missouri's financial power of attorney applies here (RSMo 404.810, RSMo 404.705):

It must be titled "Durable Power of Attorney" or include the statute's durability sentence.
You sign it and date it.
You acknowledge it before a notary, the way a real estate deed is signed.

No witnesses are required. Our Missouri power of attorney guide covers the financial document, which follows the same signing steps.

Who can't be my agent?

Some people can't serve unless they are related to you within the second degree, or belong to the same religious community (RSMo 404.815):

Your attending physician, or an employee of that physician.
An owner, operator or employee of a health care facility where you live.

So a staff member at the facility where you live can't be your agent, however kind, unless they are family.

What can my agent decide?

Your agent makes the health care decisions your document allows. Your agent is a fiduciary: legally required to act in your interest and follow what you wrote.

Two Missouri details are worth knowing:

Feeding tubes need express wording. Your agent can withhold or withdraw artificially supplied nutrition and hydration only if your document specifically grants that power (RSMo 404.820).
Two doctors, by default. Unless your document says otherwise, your agent's authority starts only after two physicians certify that you are incapacitated (RSMo 404.825).

Do I need a living will too?

Many people sign both. Missouri's living will is called a "declaration," and it is narrower than people expect (RSMo 459.010). It covers only withholding or withdrawing death-prolonging procedures in a terminal condition, and by definition it doesn't reach nutrition and hydration.

It is also signed differently from the power of attorney (RSMo 459.015):

Item	Durable power of attorney for health care	Living will declaration
What it does	Names a person to decide	States your wishes about death-prolonging procedures in a terminal condition
Witnesses	None required	Two adults, unless wholly in your handwriting
Notary	Required	Not required
Official form	None	Optional sample form

You can revoke a declaration at any time, in any way you can communicate (RSMo 459.020). Our post on health care power of attorney vs living will explains how the two fit, and treatment preferences helps you think through what to write.

Here is a typical case, a composite. Patricia is 71, divorced, and lives in Kansas City. Her daughter lives in Arizona. Her friend Ellen takes her to every appointment and knows her wishes well. Missouri law would give Ellen no say, so Patricia names Ellen as her health care agent, with her daughter as backup.

How do I choose my agent?

Once the signing is done, the practical questions matter most. Is the person willing? Can they get to the hospital? Will they follow your wishes even when they'd choose differently?

A short checklist:

They know what you want, because you've told them.
They can stay calm in a hospital hallway and ask questions.
They live close enough, or can travel when needed.
You've named a backup in case they can't.

Our post on how to choose a medical power of attorney has more questions to ask.

Some people would like a professional standing by, first or behind a friend. A Kinly membership includes a medical power of attorney written for your state, and Trella Trust Company can be named in the role, first or as the backup to someone you choose.

Once your health papers are done, our Missouri probate guide covers what happens to your home and savings later.

Common questions

Who makes medical decisions in Missouri if there's no power of attorney?

Missouri has no general law naming a family decision-maker for adults. A guardian can decide, and a narrow list applies only to experimental treatment at teaching hospitals. Naming a health care agent is the way to choose who decides.

Does a medical power of attorney need to be notarized in Missouri?

Yes. A durable power of attorney for health care must be signed, dated and acknowledged before a notary. No witnesses are required.

Can a close friend make medical decisions for me in Missouri?

Only if you name the friend in a durable power of attorney for health care. Missouri law gives a friend no default authority.

Does a Missouri living will need a notary?

No. A living will declaration needs two adult witnesses, unless it is wholly in your handwriting. It covers only death-prolonging procedures in a terminal condition.

Can my agent stop a feeding tube in Missouri?

Only if your document specifically grants authority over artificially supplied nutrition and hydration. Without that wording, your agent can't make that choice.

Sources

This page is general information, not legal or financial advice. Laws vary by state.

Keep reading

State guidesPower of attorney in Missouri: the rules, signing, who to namePower of attorney in Missouri must be labeled durable and notarized to survive incapacity, and some powers need express wording. Here's how to get it right.State guidesProbate in Missouri: small estates, no will, and skipping courtSmall estate affidavit Missouri rules: up to $40,000 after 30 days, who inherits with no will, executor fees, and how a beneficiary deed lets a house skip court.State guidesEstate planning by state: guides for all 50 statesEstate planning by state: what stays the same everywhere, what changes, and power of attorney, medical and probate guides for all 50 states.