Living Will Declaration
This Living Will is being created in accordance with the laws of [State Name]. It serves to outline my preferences regarding medical treatment in the event that I am unable to communicate my wishes.
I, [Your Full Name], born on [Your Date of Birth], residing at [Your Address], declare this Living Will on this [Date].
In the event that I become terminally ill, comatose, or in a persistent vegetative state, I desire the following medical treatments:
- If I am unable to make my wishes known, I do not want to receive life-sustaining treatment that only prolongs the dying process.
- I wish to receive comfort care to relieve pain and suffering.
- If I am capable of communicating, I prefer to discuss any treatment options directly with my healthcare provider.
Furthermore, I wish to specify my preferences concerning the following:
- Resuscitation: I do not wish to have cardiopulmonary resuscitation (CPR) performed if my heart stops or I stop breathing.
- Mechanical Ventilation: I do not wish to be placed on a ventilator if I am unable to breathe on my own.
- Tube Feeding and Hydration: I do not wish to receive artificial nutrition and hydration if I am not expected to recover.
This Living Will reflects my preferences as of today and supersedes any previous declarations I may have made. I understand that I may revoke or change this document at any time while I am still competent.
Signed:
[Your Signature]
Date: [Date]
Witnesses:
It is required to have two adult witnesses sign below, affirming that I appear to be of sound mind and under no duress during the signing of this document.
- Witness 1 Name: ________________________
- Witness 1 Signature: _____________________
- Date: ________________________________
- Witness 2 Name: ________________________
- Witness 2 Signature: _____________________
- Date: ________________________________
Please ensure that copies of this document are provided to my healthcare provider and any family members involved in my care.