Living Will
Living Will (Advance Healthcare Directive): Medical Care Preferences
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Directive Date and Declarant
1. Purpose
2. Healthcare Decisions
3. Appointment of Healthcare Proxy
4. Organ Donation
5. Revocation
6. Governing Law
Signatures
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LIVING WILL (ADVANCE HEALTHCARE DIRECTIVE) TEMPLATE
This Living Will ("Directive") is made on [Date], by:
Declarant: [Full Legal Name], residing at [Address]
1. Purpose
This Directive sets forth my instructions regarding medical treatment if I am unable to make decisions due to incapacity. It reflects my personal wishes and values concerning healthcare.
2. Healthcare Decisions
If I am in a terminal condition, permanent unconsciousness, or other state of incapacity, I direct that the following treatments be:
- Life-sustaining treatment: Accept
- Cardiopulmonary resuscitation (CPR): Accept
- Artificial nutrition and hydration: Accept
- Pain management: Describe preferences
3. Appointment of Healthcare Proxy
I appoint [Full Name], residing at [Address], as my healthcare agent to make medical decisions on my behalf if I cannot do so. If this person is unable or unwilling to serve, I appoint [No alternate agent specified].
4. Organ Donation
Upon my death, I wish to: Not donate.
5. Revocation
I may revoke this Directive at any time in writing or orally, in accordance with applicable law.
6. Governing Law
This Directive shall be governed by the laws of the State of [State].
Signature of Declarant: ________________________ Date: [Date]
Printed Name: _________________________________
Witness 1 Signature: __________________________ Date: [Date]
Printed Name: _________________________________
Witness 2 Signature: __________________________ Date: [Date]
Printed Name: _________________________________
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