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Living Will - Designed for Individual States

Living Will Sample

Living Will

This Living Will is executed in accordance with the laws of [State Name]. It expresses my wishes regarding medical treatment in the event that I am unable to communicate my wishes myself.

Declaration

I, [Your Full Name], born on [Date of Birth], residing at [Your Address], declare that this document reflects my wishes about medical treatment under the conditions specified below.

Conditions Under Which This Will Applies

  1. If I am diagnosed with a terminal condition and death is expected within a short time.
  2. If I am in a persistent vegetative state or have an irreversible condition that prevents me from communicating my wishes.

Wishes Regarding Medical Treatment

In the event that I am unable to make decisions about my medical care, I express the following wishes:

  • I do not wish to receive life-sustaining treatment if I am terminally ill.
  • I wish to receive pain relief even if it may hasten my death.
  • I do not want resuscitation attempts in the event of my heart stopping or cessation of breathing.
  • If I enter a state of unconsciousness and my condition is deemed irreversible, I prefer to forgo artificial nutrition and hydration.

Appointment of Health Care Proxy

I designate [Proxy's Full Name], residing at [Proxy's Address], as my health care proxy. In the absence of the appointed person, I designate [Alternate Proxy's Full Name], residing at [Alternate Proxy's Address], as my alternate proxy.

Revocation of Previous Living Wills

This document revokes any prior Living Wills or similar directives I have executed.

Signatures

Signed on this [Day] day of [Month], [Year].

Signature: __________________________

print name: [Your Printed Name]

Witnesses

This Living Will must be signed in the presence of two witnesses who are not related to me, do not inherit from me, and are not involved in my medical care.

  • Witness 1 Name: ______________________ Signature: ____________________ Date: ____________
  • Witness 2 Name: ______________________ Signature: ____________________ Date: ____________

Instructions on Utilizing Living Will

Filling out a Living Will form is an important step in expressing your healthcare preferences. This document will guide your loved ones and healthcare providers in making decisions about your medical care if you become unable to communicate your wishes.

  1. Obtain the Form: Find a Living Will form. You can often get one from your healthcare provider, attorney, or online legal resources.
  2. Read the Instructions: Carefully review any instructions that come with the form. Understanding the requirements is crucial.
  3. Fill in Your Personal Information: Write your full name, address, and date of birth at the top of the form.
  4. Designate a Healthcare Proxy: If desired, select someone you trust to make healthcare decisions on your behalf. Include their name and contact information.
  5. Specify Your Wishes: Clearly state your preferences regarding medical treatments, life support, and other critical decisions. Be as specific as possible.
  6. Review the Document: Go over your completed form to ensure all information is accurate and reflects your wishes.
  7. Sign and Date: Sign the form and include the date. Some states may require witnesses or notarization, so check your local laws.
  8. Distribute Copies: Provide copies of the signed Living Will to your healthcare proxy, family members, and your healthcare provider.

Misconceptions

Many people have misconceptions about Living Wills that can lead to confusion and misinformation. Here are seven common myths along with clarifications.

  • A Living Will is the same as a Last Will and Testament. This is incorrect. A Living Will outlines your medical preferences if you become unable to communicate, while a Last Will deals with the distribution of your assets after death.
  • Living Wills are only for the elderly. This is a misconception. Anyone, regardless of age, can benefit from having a Living Will, especially if they have specific medical wishes.
  • A Living Will is legally binding in all states. Not true. The legality of a Living Will can vary by state. It's important to understand the laws in your state to ensure your document is valid.
  • Once created, a Living Will cannot be changed. This is false. You can update or revoke your Living Will at any time as long as you are mentally competent.
  • Healthcare providers must follow the Living Will. While healthcare providers are generally required to respect your wishes, there may be exceptions based on state laws or specific circumstances.
  • A Living Will only covers end-of-life decisions. This is misleading. A Living Will can address various medical situations, including life-sustaining treatments and other healthcare preferences.
  • My family will know my wishes without a Living Will. This is a risky assumption. Without a formal document, family members may disagree on your wishes, leading to confusion and conflict during critical times.

Documents used along the form

A Living Will is an essential document that outlines your preferences regarding medical treatment in the event you become unable to communicate your wishes. However, it is often accompanied by several other important forms and documents that work together to ensure your healthcare decisions are honored. Below is a list of related documents that you may want to consider when preparing your Living Will.

  • Durable Power of Attorney for Healthcare: This document allows you to appoint someone to make medical decisions on your behalf if you are unable to do so. It grants authority to your chosen representative to act in your best interest.
  • Do Not Resuscitate (DNR) Order: A DNR order specifies that you do not wish to receive CPR or other life-saving measures in the event of cardiac arrest. It is typically signed by a physician and should be readily available to healthcare providers.
  • Healthcare Proxy: Similar to a Durable Power of Attorney, a healthcare proxy designates a specific person to make medical decisions for you. This is particularly useful when you want someone you trust to interpret your Living Will's instructions.
  • Sales Tax Certification Application: For businesses seeking to benefit from sales tax exemptions in designated Empire Zones, it is essential to complete the New York DTF 84 form, which you can find at nypdfforms.com/new-york-dtf-84-form.
  • Advance Directive: This is a broader term that encompasses both Living Wills and Durable Powers of Attorney. An advance directive provides clear guidance on your healthcare preferences and who can make decisions on your behalf.
  • Physician Orders for Life-Sustaining Treatment (POLST): A POLST form is a medical order that outlines your preferences for life-sustaining treatment. It is designed for patients with serious illnesses and is signed by a healthcare professional.
  • Organ Donation Registration: If you wish to donate your organs after death, this document allows you to express your wishes and can help ensure that your intentions are honored.
  • Funeral Planning Documents: While not directly related to medical care, these documents outline your wishes for funeral arrangements. They can ease the burden on your loved ones during a difficult time.

Incorporating these documents alongside your Living Will can create a comprehensive plan for your healthcare and end-of-life wishes. Taking the time to prepare these forms not only provides clarity for your loved ones but also ensures that your preferences are respected when it matters most.