California Living Will Template
This Living Will is executed under the laws of the State of California. It expresses my wishes regarding medical treatment in case I become unable to communicate my preferences.
Personal Information:
- Name: ________________________
- Date of Birth: __________________
- Address: ______________________
- Phone Number: _________________
Healthcare Instructions:
If at any time I am diagnosed with a terminal illness, or if I am in a persistent vegetative state, I direct that my wishes regarding life-sustaining treatment be as follows:
- I do not wish to receive any life-sustaining treatment if:
- My condition is terminal and I am unable to respond.
- I am in a persistent vegetative state.
- I request the withholding or withdrawal of treatment that only prolongs the dying process. This includes:
- Mechanical ventilation
- Artificial nutrition and hydration
- Cardiopulmonary resuscitation (CPR)
- In case of my inability to decide, I authorize the following person to make healthcare decisions on my behalf:
- Name: ________________________
- Relationship: __________________
- Phone Number: _______________
Signature:
By signing below, I affirm that I understand this document and that it reflects my wishes regarding my healthcare.
Signature: ________________________
Date: _____________________________
Witnesses:
This document must be witnessed by two individuals who are not related to me by blood or marriage and who will not inherit any of my property.
- Witness 1: ______________________
- Witness 2: ______________________
Date: _____________________________