Free Living Will Template - Advance Healthcare Directive Form

DECLARATION

I, ____________________________________, born on __________, residing at ____________________________________, ____________________________________, being of sound mind, willfully and voluntarily make this declaration for my end-of-life healthcare decisions.

LIFE-SUSTAINING TREATMENT

If I am diagnosed with a terminal condition or am permanently unconscious with no reasonable expectation of recovery, I direct that:

[X] Life-sustaining treatment be withdrawn or withheld

[ ] All treatment be continued regardless of condition

[ ] Trial period, then withdraw if no improvement

ARTIFICIAL NUTRITION AND HYDRATION

[X] Do not provide artificial nutrition/hydration

[ ] Provide as medically needed

[ ] Provide temporarily only

PAIN MANAGEMENT

[X] Provide maximum comfort care and pain relief

[ ] Moderate pain relief only

[ ] Minimal intervention

ORGAN DONATION

[X] I wish to donate all organs and tissues

[ ] I wish to donate only: ____________________________________

[ ] I do not wish to donate organs