New York Living Will Template
This Living Will is made in accordance with New York State law and outlines your wishes regarding medical treatment in situations where you may no longer be capable of making decisions for yourself.
Declaration of Wishes
I, [Your Full Name], residing at [Your Address], in the County of [Your County], State of New York, being of sound mind, make this Living Will to communicate my wishes concerning medical treatment in the event that I am unable to do so myself.
Definition of Terminal Condition
A terminal condition is defined as an incurable and irreversible condition that, without the provision of life-sustaining treatment, will result in death within a relatively short time frame. I understand this definition and wish to provide guidance to my healthcare providers in the event of such a condition.
Wishes Concerning Life-Sustaining Treatment
In the event that I have a terminal condition, I do not want the following treatments to be administered:
- Cardiopulmonary resuscitation (CPR)
- Mechanical ventilation
- Dialysis
- Artificial nutrition and hydration
If I cannot communicate and am diagnosed with a permanent unconscious condition or a severe and irreversible deterioration of my mental abilities, I wish to receive:
- Palliative care to relieve pain and discomfort.
- No measures that would prolong the dying process.
Appointment of Health Care Agent
I hereby appoint the following individual as my Health Care Agent, who will make healthcare decisions on my behalf if I am unable to do so:
[Agent's Full Name]
[Agent's Address]
[Agent's Phone Number]
Effect of this Living Will
This Living Will shall be effective when my attending physician determines that I am unable to make my own healthcare decisions.
Revocation of Previous Documents
This document revokes any previous Living Wills or advance directives I may have signed. This Living Will reflects my current wishes and may be revised or revoked by me at any time.
Signatures
In Witness Whereof, I have signed this Living Will on this [Date].
[Your Signature]
[Your Printed Name]
Witnesses
We, the undersigned witnesses, affirm that the individual who signed this Living Will is known to us and appears to be of sound mind, able to make this declaration.
[Witness 1 Full Name]
[Witness 1 Signature]
[Witness 1 Address]
[Date]
[Witness 2 Full Name]
[Witness 2 Signature]
[Witness 2 Address]
[Date]