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Pennsylvania Living Will

This Living Will is made pursuant to the laws of the Commonwealth of Pennsylvania. It expresses my wishes regarding medical treatment in the event that I become unable to communicate my desires.

Personal Information:

  • Full Name: ___________________________
  • Date of Birth: ________________________
  • Address: ______________________________
  • City, State, Zip: _____________________
  • Phone Number: ________________________

Declaration:

If I am diagnosed with a terminal condition, or if I am in a state of permanent unconsciousness, I wish to provide the following directives regarding my medical treatment:

  1. I do not want my life to be prolonged by medical means if I have no reasonable chance of recovery.
  2. I specifically request that the following interventions not be used:
  • Respiratory assistance (e.g., ventilators)
  • Cardiac resuscitation
  • Nutrition and hydration through invasive means
  • Any other life-sustaining treatments deemed necessary

If I am unable to speak for myself, I wish for My Health Care Agent to make decisions about my care on my behalf. My Health Care Agent shall be:

Name: ___________________________

Contact Information: ___________________________

Signatures:

This Living Will is signed voluntarily by me, and I affirm that I understand its contents. I expect my wishes as stated herein to be respected and honored.

Signature of Declarant: _______________________________

Date: ___________________________

Witnesses:

  1. Name: ___________________________ Signature: __________________________ Date: _______________
  2. Name: ___________________________ Signature: __________________________ Date: _______________

Note: This Living Will must be signed in front of two adult witnesses who are not related to you, nor are beneficiaries of your estate.

Common mistakes

Filling out a Pennsylvania Living Will form can be a daunting task, and mistakes are more common than one might think. Understanding these pitfalls can help ensure that your wishes are clearly communicated. One common error is failing to specify your preferences regarding medical treatment. Without clear instructions, healthcare providers may not understand your desires, leading to unwanted interventions.

Another frequent mistake is neglecting to date the form. A Living Will must be current to be valid. If the document lacks a date, it may raise questions about its legitimacy, and healthcare providers might hesitate to follow its instructions. Additionally, people often forget to sign the form. A signature is essential for the document to be recognized as legally binding, and without it, your wishes may not be honored.

Moreover, many individuals overlook the importance of choosing an appropriate witness. Pennsylvania law requires that your Living Will be signed in the presence of two witnesses who are not related to you or entitled to any portion of your estate. Failing to meet this requirement could invalidate the document. It’s also crucial to ensure that the witnesses are present when you sign the form; otherwise, it may lead to complications later.

Another mistake involves using vague language. Phrases like “I do not want to be kept alive” can be interpreted in various ways. Instead, it’s better to be specific about the types of treatments you do or do not want. This clarity can prevent misunderstandings and ensure that your healthcare team knows your true preferences.

People often forget to review their Living Will periodically. As life circumstances change, so might your preferences regarding medical treatment. Regularly updating the document ensures that it reflects your current wishes. Additionally, failing to communicate your Living Will to family members can lead to confusion and disputes during critical moments. Sharing your wishes with loved ones can provide peace of mind and clarity for everyone involved.

Lastly, many individuals do not keep a copy of their Living Will in an accessible location. It’s essential to store the document where it can be easily found in an emergency. Whether it’s a digital copy saved on your phone or a physical copy in a safe place, having it readily available can make a significant difference when decisions need to be made swiftly.

Dos and Don'ts

When filling out the Pennsylvania Living Will form, it is important to approach the task with care and consideration. Here are six key things to remember, including both actions to take and pitfalls to avoid.

  • Do ensure you understand the purpose of a Living Will. It is designed to outline your wishes regarding medical treatment in the event you become unable to communicate.
  • Don't leave any sections blank. Complete all required fields to avoid confusion or misinterpretation of your wishes.
  • Do discuss your decisions with family members or loved ones. Open conversations can help ensure your wishes are respected.
  • Don't use vague language. Be specific about your preferences for medical treatments and interventions.
  • Do sign and date the form in the presence of witnesses. This step is crucial for the document's validity.
  • Don't forget to keep copies of your Living Will. Share them with your healthcare provider and loved ones to ensure everyone is informed.
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Similar forms

  • Advance Directive: This document encompasses both a Living Will and a Durable Power of Attorney for Health Care. It allows individuals to outline their medical preferences and appoint someone to make decisions on their behalf if they become unable to do so.
  • Marriage Certificate: A Marriage Certificate is a crucial legal document affirming the union between two individuals. To learn more about the requirements for obtaining this important form, visit TopTemplates.info.
  • Durable Power of Attorney for Health Care: This legal document specifically designates an agent to make health care decisions for an individual when they are incapacitated. Unlike a Living Will, it focuses more on appointing a trusted person rather than detailing specific medical wishes.
  • Do Not Resuscitate (DNR) Order: A DNR order is a medical directive that instructs healthcare providers not to perform CPR in the event of cardiac arrest. While a Living Will may include similar wishes, a DNR is specifically focused on resuscitation efforts.
  • Health Care Proxy: This document allows an individual to appoint someone to make health care decisions on their behalf. It is similar to a Durable Power of Attorney but is often used in conjunction with a Living Will to ensure comprehensive health care planning.
  • Physician Orders for Life-Sustaining Treatment (POLST): A POLST form translates a patient's wishes regarding life-sustaining treatment into medical orders. It is similar to a Living Will but is intended for individuals with serious health conditions who may require immediate medical attention.
  • Organ Donation Document: This document expresses an individual's wishes regarding organ donation after death. While a Living Will focuses on medical treatment preferences, an organ donation document specifically addresses the disposition of one's body after death.
  • Mental Health Advance Directive: This document allows individuals to outline their preferences for mental health treatment in case they become unable to communicate their wishes. It complements a Living Will by addressing mental health needs specifically.
  • End-of-Life Care Plan: This plan provides detailed instructions regarding the type of care an individual wishes to receive at the end of their life. It overlaps with a Living Will but often includes broader considerations about emotional and spiritual support.
  • Financial Power of Attorney: While primarily focused on financial matters, this document allows a designated person to manage an individual's financial affairs if they become incapacitated. It is similar in concept to a Durable Power of Attorney for Health Care, though it pertains to financial decisions rather than health care choices.