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Homepage Attorney-Approved Living Will Form

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Living Will for [State Name] Residents

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

Personal Information

Full Name: ___________________________________________

Date of Birth: ______________________________________

Address: _____________________________________________

City, State, Zip Code: ______________________________

Phone Number: ______________________________________

Medical Preferences

In the event that I am diagnosed with a terminal illness or a condition that leaves me in a persistent vegetative state, I express the following wishes regarding my medical treatment:

Life-Sustaining Treatments

Initial only one option:

  • ___ I wish to receive life-sustaining treatments, including but not limited to resuscitation, mechanical ventilation, and artificial nutrition and hydration.
  • ___ I do not wish to receive life-sustaining treatments if I am in a terminal condition.
  • ___ I wish to receive only comfort care measures to relieve pain and suffering.

Additional Instructions

Please specify any additional wishes regarding treatment or care:

__________________________________________________________

Organ Donation

Initial only one option:

  • ___ I wish to donate any needed organs or tissues.
  • ___ I do not wish to donate any organs or tissues.

Designation of Health Care Proxy

I designate the following person to act as my Health Care Proxy. They are authorized to make health care decisions on my behalf if I am unable to do so:

Name: ___________________________________________

Address: ______________________________________

Phone Number: __________________________________

Signature

By signing below, I affirm that I am of sound mind and that I am making this Living Will voluntarily, without coercion:

Signature: ________________________________________

Date: ___________________________________________

Witnesses

This Living Will must be signed in the presence of two witnesses who are not related to me and have no financial interest in my estate:

  1. Name: ___________________________________________ Signature: ________________________
  2. Name: ___________________________________________ Signature: ________________________

Common mistakes

Creating a Living Will is an important step in ensuring that your healthcare preferences are honored. However, many individuals make common mistakes when filling out this form. Understanding these pitfalls can help you avoid them and ensure your wishes are clearly communicated.

One frequent error is failing to provide specific instructions regarding medical treatment. A Living Will should outline your preferences for life-sustaining treatments, such as resuscitation or mechanical ventilation. Without clear directives, healthcare providers may struggle to interpret your wishes, leading to decisions that may not align with your values.

Another mistake is neglecting to update the Living Will as circumstances change. Life events such as a new diagnosis, changes in personal beliefs, or shifts in family dynamics can impact your healthcare preferences. Regularly reviewing and updating your Living Will ensures that it accurately reflects your current wishes.

Some individuals also overlook the importance of having witnesses or notarization. Most states require that the Living Will be signed in the presence of witnesses or notarized to be legally valid. Failing to adhere to these requirements can result in the document being deemed invalid, which defeats its purpose.

Additionally, people often forget to discuss their Living Will with family members. Open communication about your healthcare preferences can prevent confusion and conflict during critical moments. When loved ones are informed about your wishes, they can advocate on your behalf more effectively.

A lack of clarity in language can also lead to misunderstandings. Using vague terms or medical jargon may create ambiguity about your intentions. It’s crucial to use straightforward language that clearly conveys your desires to ensure that healthcare providers and family members understand your wishes.

Finally, some individuals fail to store their Living Will in an accessible location. It is essential to keep the document in a place where family members or healthcare providers can easily find it when needed. Consider providing copies to your healthcare proxy and ensuring that your loved ones know where to locate it.

By being aware of these common mistakes, you can take proactive steps to create a Living Will that accurately reflects your healthcare preferences and ensures that your wishes are respected.

Dos and Don'ts

When filling out a Living Will form, it’s important to approach the process thoughtfully. Here are some guidelines to help you navigate this important task.

  • Do: Clearly state your wishes regarding medical treatment.
  • Do: Discuss your preferences with family members and healthcare providers.
  • Do: Review the document regularly to ensure it still reflects your wishes.
  • Do: Sign and date the form in the presence of witnesses, if required.
  • Don’t: Rush through the form; take your time to consider your decisions.
  • Don’t: Leave out important details that may affect your care.

By following these guidelines, you can ensure that your Living Will accurately reflects your wishes and provides clarity for your loved ones and healthcare providers.

Similar forms

  • Advance Directive: This document outlines a person's healthcare preferences in advance, similar to a Living Will, and may include instructions for medical treatment if the individual becomes unable to communicate.
  • Durable Power of Attorney for Healthcare: This allows someone to make medical decisions on behalf of another person if they are incapacitated. It complements a Living Will by designating a trusted individual to act on one’s behalf.
  • Do Not Resuscitate (DNR) Order: A DNR specifies that a person does not want to receive CPR if their heart stops or they stop breathing. It directly relates to end-of-life decisions outlined in a Living Will.
  • Healthcare Proxy: Similar to a Durable Power of Attorney, a healthcare proxy appoints someone to make healthcare decisions for another person when they cannot do so themselves.
  • Durable Power of Attorney: A Durable Power of Attorney form is a legal document that grants someone else the authority to make decisions on your behalf, should you become unable to do so. This power remains in effect even if you become incapacitated, providing peace of mind and continuity in managing your affairs. It's a crucial tool for planning for the unexpected, allowing you to choose a trusted individual to act in your best interests. For more information, visit TopTemplates.info.

  • Physician Orders for Life-Sustaining Treatment (POLST): This document provides specific medical orders regarding treatment preferences and is often used in conjunction with a Living Will to ensure that wishes are honored in a medical setting.
  • Do Not Intubate (DNI) Order: This document indicates that a person does not wish to be intubated if they cannot breathe on their own, aligning with the intent of a Living Will regarding life-sustaining measures.
  • Organ Donation Form: This form expresses a person’s wishes regarding organ donation after death. It can be part of a broader discussion about end-of-life decisions, similar to those addressed in a Living Will.
  • Emergency Medical Services (EMS) Directive: This directive informs emergency responders of a person’s healthcare wishes during emergencies, ensuring that their preferences are respected in critical situations.
  • Patient Advocate Designation: This document allows individuals to appoint someone to advocate for their healthcare wishes, similar to how a Living Will outlines those wishes in writing.
  • End-of-Life Care Plan: This plan details preferences for care and treatment at the end of life, aligning closely with the intentions expressed in a Living Will.