Living Will
This Living Will is executed in accordance with the laws of [State Name]. It provides guidance regarding my healthcare decisions in the event that I am unable to communicate my wishes.
I, [Your Full Name], residing at [Your Address], born on [Your Date of Birth], hereby declare this to be my Living Will.
In the event that I am diagnosed with a terminal condition, a state of permanent unconsciousness, or another medical condition that would prevent me from making my own healthcare decisions, I hereby instruct that:
- I do not wish to receive any life-sustaining treatment if it will only prolong the dying process.
- I do wish to receive comfort care, including but not limited to pain relief, even if it may hasten my death.
- I grant permission to withhold or withdraw treatment as specified in this document.
I designate the following individual as my healthcare representative to make decisions on my behalf if I am unable to do so:
- Name: [Designated Representative's Name]
- Relationship: [Relationship to You]
- Contact Information: [Phone Number/Email]
In the absence of my designated representative, I request that my wishes regarding medical treatment be honored by:
- Second Alternate: [Name and Contact Information]
This Living Will reflects my wishes as of the date indicated below. I reserve the right to revoke or change this document at any time, as long as I am competent to do so.
Signed this ____ day of ____________, 20__.
Signature: ________________________________
Printed Name: [Your Full Name]
Witness #1: ________________________________
Printed Name: _________________________
Witness #2: ________________________________
Printed Name: _________________________
This document must be signed in the presence of two witnesses, who are not related to me or entitled to any part of my estate.