Important
Notice
This
is a typical FORM that is available on
the Internet. You are free to use it. But consider
this:
As
you can see, it doesn't allow for specific conditions
for your care or give requirements for you to
receive comfort care. It also doesn't appoint
a particular person to represent your
wishes and determine the limits to their power.
You
can see why this and similar forms may
be severly lacking in making certain your wishes
are honored. The small price of $19.97 may be
one of the most wise decisions you can make. |
Living
Will
LIVING WILL
I, _______________________, of _______________________, being
of sound mind, do hereby willfully and voluntarily make known
my desire that my life not be prolonged under any of the following
conditions, and do hereby further declare:
1. If I should, at any time, have an incurable condition caused by any
disease or illness, or by any accident or injury, and be determined by
any two or more physicians to be in a terminal
condition whereby the use of "heroic measures" or the application of
life-sustaining procedures would only serve to delay the moment of my
death, and where my attending physician has determined that my death is
imminent whether or not such "heroic measures" or life-sustaining
measures are employed, I direct that such measures and procedures be
withheld or withdrawn and that I be permitted to die naturally.
2. In the event of my inability to give directions regarding the
application of life-sustaining procedures or the use of "heroic
measures", it is my intention that this directive shall be honored by
my family and physicians as my final expression of my right to refuse
medical and surgical treatment, and my acceptance of the consequences
of such refusal.
3. I am mentally, emotionally and legally competent to make this directive and I fully understand its import.
4. I reserve the right to revoke this directive at any time.
5. This directive shall remain in force until revoked.
IN WITNESS WHEREOF, I have hereto set my hand and seal this
_(3)_ day of ______________, 20__.
____________________________
Declaration of Witnesses
The declarant is personally known to me and I believe him to be of
sound mind and emotionally and legally competent to make the herein
contined Directive to Physicians. I am not related to the declarant by
blood or marriage, nor would I be entitled to any portion of the
declarant's estate upon his decease, nor am I an attending physician of
the declarant, nor an employee of the attending physician, nor an
employee of a health care facility in which the declarant is a patient,
nor a patient in a health care facility in which the declarant is a
patient, nor am I a person who has any claim against any portion of the
estate of the declarant upon his death.
_____________________________
_____________________________
_____________________________
_____________________________
_____________________________
_____________________________
NOTICE
The information in this document is designed to provide an outline that
you can follow when formulating business or personal plans. Due to the
variances of many local, city, county and state laws, we recommend that
you seek professional legal counseling before entering into any
contract or agreement.
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