Rhode Island Advance Directive: What You Need to Complete in 2026

Rhode Island is one of only four states without a default family surrogate consent law. If you become incapacitated without an advance directive, your spouse and adult children have zero automatic legal authority to make medical decisions for you — even in an emergency. The only remedy is a formal guardianship petition through your municipal probate court, which typically costs $5,000 to $15,000 in legal fees.

That legal gap makes completing a Rhode Island advance directive genuinely urgent, not just "good planning."

Rhode Island Uses Two Separate Documents, Not One

Unlike most states that combine everything into a single advance directive form, Rhode Island splits healthcare planning into two distinct statutory instruments:

The Durable Power of Attorney for Healthcare (DPOAH) — authorized under R.I. Gen. Laws § 23-4.10-2 — lets you name a healthcare agent to make medical decisions if you lose capacity. This applies to any incapacitation, temporary or permanent, terminal or not. Your agent can consent to, refuse, or withdraw any treatment unless you specifically limit their authority.

The Living Will (Declaration) — governed by the Rights of the Terminally Ill Act, R.I. Gen. Laws § 23-4.11-3 — is narrower. It instructs physicians to withhold or withdraw life-sustaining procedures only when you have an incurable terminal condition and cannot make your own decisions.

You need both. The DPOAH covers the broader scenario (a stroke, a car accident, early-stage dementia), while the Living Will provides specific end-of-life instructions when you're terminally ill.

Witness and Notary Rules Differ by Document

Rhode Island's execution requirements catch people off guard because the two documents have different signing rules.

For the Living Will: You must sign before two witnesses. Notarization alone does not work — the statute does not recognize it as an alternative. Both witnesses must be unrelated to you by blood or marriage and must not be entitled to any portion of your estate.

For the DPOAH: You can choose either two witnesses or one notary public. If you use witnesses, neither can be your designated healthcare agent, a healthcare provider, or an employee of a healthcare facility. At least one witness (or the notary) must declare under penalty of perjury that they are unrelated and have no claim on your estate.

These rules mean that completing your advance directive in a nursing home or hospital is complicated — most available adults there are disqualified by their employment.

What Happens If You Don't Have One

Rhode Island joins Massachusetts, Minnesota, and Missouri as the only states lacking a default surrogate statute. In 46 other states, hospitals can follow a spouse's or adult child's instructions without paperwork. In Rhode Island, they cannot.

Without a valid DPOAH, your family faces a guardianship petition in whichever of Rhode Island's 39 municipal probate courts serves your town. Even uncontested guardianships regularly run $5,000 to $15,000 in attorney fees, take weeks to process, and strip the incapacitated person of fundamental legal rights.

The Artificial Nutrition Checkbox Matters

Rhode Island law requires you to make an explicit, affirmative choice about artificial nutrition and hydration on your Living Will. If you don't check the box authorizing the withholding of tube feeding and IV fluids, medical providers are legally obligated to continue them — even if all other life-prolonging measures are stopped.

This is not a default you want to leave to chance. Many people assume that refusing "life-sustaining treatment" covers everything, but Rhode Island carves out artificial nutrition as a separate decision that requires its own affirmative authorization.

Organ Donation and Your DPOAH

Rhode Island law allows you to indicate organ donation preferences directly within the DPOAH. If you include this designation, your healthcare agent is authorized to enforce it. You can also register separately through the Rhode Island Division of Motor Vehicles on your driver's license.

If organ donation is important to you, including it in the DPOAH creates a legally binding instruction that hospitals must honor — stronger than a driver's license notation alone.

Pregnancy Limitations

Under Rhode Island law, both the DPOAH and Living Will are suspended if you are pregnant and life-sustaining treatment could allow the fetus to develop to a live birth. This means that even a clearly stated preference to withdraw treatment may be overridden if a physician determines the pregnancy is viable.

If you are of childbearing age, be aware of this statutory limitation when completing your documents.

How Advance Directives Connect to MOLST and DNR Orders

Your advance directive handles future planning. But when a terminal diagnosis arrives, those preferences need to be translated into immediate medical orders that EMTs and hospital staff can follow in real time.

Rhode Island uses two clinical tools for this transition:

• MOLST (Medical Orders for Life-Sustaining Treatment): A bright pink medical order form completed by a physician with the patient or their healthcare agent. Active immediately upon signing and binding on all medical staff.
• Comfort One bracelet: Rhode Island's out-of-hospital DNR program. A serialized metal bracelet issued by a physician that tells EMTs not to perform CPR.

These are separate from your advance directive and are completed later, when the medical situation warrants it. Your DPOAH and Living Will should be done now, while you are healthy and competent.

Next Steps

A complete Rhode Island advance directive package should include both the DPOAH and Living Will, properly witnessed according to the different rules for each document. If you want step-by-step guidance through the entire process — including witness eligibility checklists, agent selection worksheets, and MOLST/Comfort One reference material — the Rhode Island Advance Directive & Living Will Kit walks you through everything for this state's specific requirements.

See more Rhode Island guides →