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Pennsylvania Living Will Template

This Living Will is created in accordance with the laws of the Commonwealth of Pennsylvania. It reflects my wishes regarding medical treatment in the event that I become unable to communicate my preferences.

Instructions for Use:

This document is meant to convey your wishes about medical treatment. Fill in the blanks with your personal information and preferences. Keep a copy for yourself and share copies with your healthcare proxies and family members.

Personal Information:

  • Full Name: __________________________
  • Date of Birth: ______________________
  • Address: ___________________________
  • City, State, ZIP: ____________________
  • Phone Number: ______________________

Declaration:

If I am diagnosed with a terminal illness or a condition that results in my inability to make medical decisions, I direct my healthcare providers to provide or withhold the following treatments:

  1. Life-Sustaining Treatment: I do/do not wish to receive life-sustaining treatments (such as mechanical ventilation, resuscitation, or feeding tubes). (Please circle one)
  2. Pain Management: I want pain management provided even if it may hasten my death.
  3. Other Instructions: _______________________________________

Healthcare Proxy:

I appoint the following individual as my healthcare proxy to make decisions on my behalf when I am unable to do so:

  • Name: ___________________________
  • Relationship: _____________________
  • Phone Number: ____________________

Signature:

I understand this document and affirm that it reflects my wishes. I sign this Living Will on this date:

Date: _________________________

Signature: ______________________

Witnesses:

This document must be witnessed by two individuals who do not stand to gain from my decisions:

  • Witness 1 Name: __________________________
  • Witness 1 Signature: ______________________
  • Date: _________________________
  • Witness 2 Name: __________________________
  • Witness 2 Signature: ______________________
  • Date: _________________________

This Living Will is duly executed according to the laws of the Commonwealth of Pennsylvania.

Documents used along the form

A Pennsylvania Living Will is an important document that outlines your wishes regarding medical treatment in case you become unable to communicate. However, there are several other forms and documents that can complement a Living Will. Here’s a list of some of the most commonly used forms.

  • Durable Power of Attorney for Health Care: This document allows you to appoint someone to make medical decisions on your behalf if you are unable to do so. It ensures that your healthcare preferences are respected.
  • Durable Power of Attorney: This legal document allows someone to make important decisions on your behalf, especially if you become unable to do so yourself. Understanding this form and how to fill it out properly can offer peace of mind for both you and your loved ones. More information can be found at Durable Power of Attorney.
  • Advance Directive: This is a broader term that includes both a Living Will and a Durable Power of Attorney for Health Care. It provides guidance on your medical care preferences and appoints a decision-maker.
  • Do Not Resuscitate (DNR) Order: A DNR order indicates that you do not wish to receive CPR or other life-saving measures in case of cardiac arrest. It must be signed by a physician.
  • Physician Orders for Life-Sustaining Treatment (POLST): This is a medical order that specifies your treatment preferences in more detail than a Living Will. It is often used for individuals with serious health conditions.
  • Health Care Proxy: Similar to a Durable Power of Attorney, this document designates someone to make healthcare decisions for you if you cannot. It is often used interchangeably with the Durable Power of Attorney.
  • Organ Donation Form: This form allows you to express your wishes regarding organ donation after your death. It can be included with your Living Will or kept separate.
  • Funeral Planning Document: While not a medical document, this form outlines your preferences for funeral arrangements. It can help relieve your loved ones from making difficult decisions during a challenging time.
  • Personal Health Record: This is a comprehensive document that contains your medical history, medications, allergies, and other health information. It can be useful for your healthcare proxy or providers in emergencies.

Having these documents in place can provide clarity and peace of mind for both you and your loved ones. It ensures that your wishes are known and respected in various situations related to healthcare and end-of-life decisions.

Similar forms

  • Advance Directive: Like a Living Will, an Advance Directive outlines your preferences for medical treatment in situations where you cannot communicate your wishes. It often combines both the Living Will and a Durable Power of Attorney for Healthcare.
  • Durable Power of Attorney for Healthcare: This document allows you to appoint someone to make healthcare decisions on your behalf if you become incapacitated. It complements the Living Will by providing a designated individual to interpret and act on your wishes.
  • Do Not Resuscitate (DNR) Order: A DNR order specifically instructs medical personnel not to perform CPR if your heart stops or you stop breathing. This document aligns with the goals of a Living Will by expressing your desire to avoid certain life-saving measures.
  • Physician Orders for Life-Sustaining Treatment (POLST): Similar to a Living Will, a POLST is a medical order that outlines your preferences for treatments, including resuscitation and life support. It is intended for individuals with serious health conditions and is signed by a healthcare professional.
  • Healthcare Proxy: A Healthcare Proxy designates a person to make medical decisions for you when you are unable to do so. While a Living Will specifies your wishes, a Healthcare Proxy provides the authority to someone else to make those choices.
  • Organ Donation Consent Form: This document expresses your wishes regarding organ donation after your death. It complements the Living Will by addressing what happens to your body after you pass away, particularly if you wish to donate organs.
  • Articles of Incorporation: This document is essential for establishing a corporation in Florida and is a legal requirement for recognition by the state. For more information, refer to the Articles of Incorporation.
  • End-of-Life Care Plan: An End-of-Life Care Plan outlines your preferences for care during the final stages of life. This document aligns with the Living Will by ensuring that your values and wishes are respected as you approach the end of life.

Misconceptions

Misconceptions about the Pennsylvania Living Will form can lead to confusion and misinformed decisions regarding end-of-life care. Here are five common misconceptions:

  • Living Wills are only for the elderly. Many people believe that living wills are only necessary for older individuals. In reality, anyone over the age of 18 can benefit from having a living will, as unexpected medical situations can arise at any age.
  • A Living Will is the same as a Do Not Resuscitate (DNR) order. Some individuals confuse living wills with DNR orders. While both documents address end-of-life care, a living will outlines preferences for medical treatment, whereas a DNR specifically instructs medical personnel not to perform CPR.
  • Once created, a Living Will cannot be changed. Many people think that a living will is a permanent document. However, individuals can modify or revoke their living wills at any time, as long as they are mentally competent to do so.
  • A Living Will guarantees that my wishes will be followed. While a living will provides guidance, it does not guarantee that all medical personnel will follow the stated wishes. Healthcare providers may interpret the document differently, and state laws may also affect its enforceability.
  • Living Wills are only necessary if I have a terminal illness. Some believe that living wills are only relevant for those diagnosed with terminal conditions. In fact, a living will can be crucial for anyone who wishes to clarify their medical treatment preferences in the event of incapacitation, regardless of their current health status.

Understanding Pennsylvania Living Will

  1. What is a Living Will in Pennsylvania?

    A Living Will is a legal document that allows individuals to express their wishes regarding medical treatment in the event they become unable to communicate those wishes themselves. It specifically addresses decisions about life-sustaining treatments, such as resuscitation, mechanical ventilation, and feeding tubes.

  2. Who can create a Living Will in Pennsylvania?

    Any adult who is at least 18 years old and of sound mind can create a Living Will in Pennsylvania. This means that the person must understand the nature of the document and the consequences of their decisions regarding medical treatment.

  3. What should be included in a Living Will?

    A Living Will should clearly outline your preferences regarding medical interventions in specific situations. Common elements include:

    • Preferences about resuscitation efforts
    • Wishes regarding artificial nutrition and hydration
    • Decisions about life support in terminal conditions
    • Any specific instructions regarding pain management
  4. How does one create a Living Will in Pennsylvania?

    To create a Living Will, an individual can either use a standard form provided by the state or draft their own document. It is important that the document is signed and dated in the presence of two witnesses, who must also sign the document. Alternatively, a notary public can be used to validate the document.

  5. Can a Living Will be changed or revoked?

    Yes, a Living Will can be changed or revoked at any time as long as the individual is of sound mind. To revoke a Living Will, one can simply destroy the document or create a new one that explicitly states the revocation of previous directives.

  6. Is a Living Will the same as a Durable Power of Attorney for Healthcare?

    No, a Living Will and a Durable Power of Attorney for Healthcare are different documents. A Living Will outlines your wishes regarding medical treatment, while a Durable Power of Attorney allows you to appoint someone to make healthcare decisions on your behalf if you are unable to do so. Both documents can work together to ensure your healthcare preferences are honored.

  7. Where should a Living Will be kept?

    It is advisable to keep the original Living Will in a safe yet accessible place. Inform your family members, healthcare providers, and appointed agents about its location. Additionally, consider providing copies to your primary care physician and any specialists involved in your care.

  8. What happens if I do not have a Living Will?

    If you do not have a Living Will and become unable to communicate your wishes, healthcare providers will follow standard medical protocols. This may result in treatments that you might not have wanted. Family members may be consulted to make decisions, but without a clear directive, this can lead to confusion and potential disagreements.