New York Living Will Template
This Living Will is created in accordance with the laws of the State of New York. It outlines my wishes regarding medical treatment in the event that I become incapacitated and unable to communicate my preferences.
Personal Information:
- Name: _______________________________
- Date of Birth: ______________________
- Address: ____________________________
- City, State, Zip Code: ______________
Designated Healthcare Agent:
I hereby appoint the following individual as my healthcare agent:
- Name of Agent: _______________________
- Address of Agent: ____________________
- Phone Number of Agent: ______________
Statement of Wishes:
If I am diagnosed with a terminal condition or in a persistent vegetative state, I wish to make the following directives regarding my medical treatment:
- If my condition is terminal, I do not wish to receive life-sustaining treatment that will only prolong the dying process.
- If I am in a persistent vegetative state, I choose not to be kept alive by artificial means.
- I desire comfort care to be provided to alleviate pain and suffering.
- I wish to have my wishes respected and communicated to all healthcare providers involved in my care.
Additional Instructions:
In addition to the statements above, I may provide specific instructions regarding other medical treatments. Here, I specify:
______________________________________________________________________
Signature:
I have executed this Living Will on the date indicated below.
Date: _______________________________
Signature: __________________________
Witnesses:
- Witness 1 Name: ____________________
- Witness 1 Signature: _______________
- Witness 2 Name: ____________________
- Witness 2 Signature: _______________
This document accurately reflects my wishes regarding medical treatment. I understand that I may revoke or amend this Living Will at any time.
