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New York Living Will Template

This Living Will is created under the laws of the State of New York. It outlines my wishes regarding medical treatment in the event that I become unable to communicate them myself.

Principal Information

  • Name: ____________________________
  • Date of Birth: ____________________________
  • Address: ____________________________
  • City, State, Zip Code: ____________________________

Declaration

I, ____________________________ (insert name), being of sound mind, willfully and voluntarily make this statement regarding my healthcare choices. I understand that this document may be used to help guide my medical treatment in the event I am unable to make decisions for myself due to illness or injury.

Wishes for Medical Treatment

If I am diagnosed with a terminal condition or am in a state of permanent unconsciousness, I direct that:

  • Life-sustaining treatments be withheld if these treatments will only prolong the dying process.
  • Pain relief should always be provided, even if it may hasten the end of life.
  • I wish to die with dignity, free from unnecessary pain and suffering.

Appointment of Agent

If I am unable to make medical decisions, I designate the following person to act on my behalf:

  • Name: ____________________________
  • Relationship: ____________________________
  • Phone Number: ____________________________

Signature

This Living Will becomes effective as of the date it is signed. I confirm that I am signing this document willingly and that I have discussed my preferences with my healthcare agent and family.

Signed this _____ day of ____________, 20__.

Signature: ____________________________

Witnesses:

  1. ____________________________ (Signature, Print Name)
  2. ____________________________ (Signature, Print Name)

Note: It is advisable to consult with an attorney or healthcare professional when creating your Living Will to ensure it reflects your wishes and complies with current laws.

Common mistakes

Filling out a New York Living Will form can be a straightforward process, but many people make common mistakes that can lead to confusion or issues later on. One frequent error is not being specific about medical preferences. It’s essential to clearly state what types of treatments or interventions you want or do not want in various medical situations. Vague statements can leave room for interpretation, which may not reflect your true wishes.

Another common mistake is failing to sign the document properly. A Living Will must be signed by you, the person making the will, to be valid. Additionally, having the appropriate witnesses is crucial. New York law requires that the form be signed in the presence of at least two witnesses who are not related to you or beneficiaries of your estate. Neglecting this step can render the document invalid.

People often overlook updating their Living Will. Life circumstances change, and so do personal preferences. If you experience significant life events, such as marriage, divorce, or a serious health diagnosis, it's important to revisit and revise your Living Will accordingly. An outdated document may not accurately represent your current wishes.

Lastly, some individuals forget to discuss their Living Will with family members or healthcare proxies. Open communication can help ensure that your loved ones understand your wishes and can advocate for you if necessary. Without this discussion, there may be confusion or disagreement among family members during critical times.

Dos and Don'ts

When filling out the New York Living Will form, it's important to approach the process carefully. Here are ten things to consider:

  • Do read the entire form thoroughly before starting.
  • Do consult with a healthcare professional if you have questions.
  • Do clearly state your wishes regarding medical treatment.
  • Do ensure that your signature is dated.
  • Do keep a copy of the completed form for your records.
  • Don't rush through the form without understanding each section.
  • Don't leave any sections blank unless instructed.
  • Don't use ambiguous language that could be misinterpreted.
  • Don't forget to discuss your wishes with your family or designated healthcare proxy.
  • Don't overlook the importance of updating the document if your wishes change.
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Similar forms

  • Advance Directive: Similar to a Living Will, an Advance Directive encompasses both a Living Will and a Durable Power of Attorney for Health Care. It outlines an individual's preferences for medical treatment and designates someone to make decisions on their behalf if they become unable to do so.

  • Durable Power of Attorney for Health Care: This document allows a person to appoint a specific individual to make health care decisions on their behalf. Unlike a Living Will, which focuses on specific medical treatments, this document grants broader authority to the appointed agent.

  • Do Not Resuscitate (DNR) Order: A DNR order is a medical order that prevents healthcare providers from performing CPR if a person's heart stops beating. It is similar to a Living Will in that it communicates a person's wishes regarding end-of-life care.

  • Employment Verification Form: This essential document is used by employers to confirm an individual's employment status, including job titles and dates of employment. For more information, you can visit documentonline.org/blank-employment-verification/.

  • Health Care Proxy: This document designates an individual to make health care decisions for someone who is incapacitated. Like a Living Will, it ensures that a person's medical preferences are honored, but it focuses more on appointing a decision-maker rather than detailing specific treatment choices.

  • Physician Orders for Life-Sustaining Treatment (POLST): A POLST form translates a patient's wishes regarding life-sustaining treatment into actionable medical orders. It is similar to a Living Will in that it reflects a person's preferences, but it is intended for those with serious illnesses and is often used in conjunction with other advance care planning documents.