Living Will Declaration
This Living Will is created in accordance with the laws of the state of [State]. It expresses my wishes regarding my medical treatment in the event that I become unable to communicate my preferences.
I, [Your Full Name], born on [Date of Birth], residing at [Your Address], declare this to be my Living Will.
In the event that I am diagnosed with a terminal condition or a condition that impairs my ability to communicate, I make the following preferences known:
- I desire that my healthcare providers offer me comfort and relief from suffering.
- I do not wish to receive life-sustaining treatments if:
- My condition is terminal and I am unable to regain consciousness to participate in decisions regarding my care.
- My healthcare providers determine that I am in a persistent vegetative state with no reasonable chance of recovery.
- I wish to make my end-of-life healthcare decisions known to my family and healthcare representatives, highlighted as follows:
- I prefer to die naturally, with minimal medical intervention.
- I, however, permit the administration of medication to alleviate pain, even if it may hasten my death.
In addition to the above statements, I designate the following person as my healthcare proxy:
[Proxy Name], residing at [Proxy Address], shall have the authority to make healthcare decisions on my behalf if I am unable to do so.
This Living Will represents my wishes and reflects my values. I understand that I can revoke or amend this document at any time while I am still competent to do so.
Signed this ____ day of __________, 20___.
______________________________
[Your Signature]
Witnesses:
This Living Will must be witnessed by two individuals or notarized, as required under [State] law.
- [Witness 1 Name], Signature: _____________________
- [Witness 2 Name], Signature: _____________________