Living Will
LIVING WILL
I, [Sender.FirstName][Sender.LastName], a resident of [Sender.City], [Sender.State] in [Sender.Country], with an address at [Sender.StreetAddress], being of sound mind, memory, disposition, understanding, and at least eighteen years of age, do willfully and freely, by this Living Will, direct my family, physician(s), attorney, and any other individuals who may in the future become responsible for my health and well-being and any decisions related thereto, whether partly or fully, to take the following actions in each of the circumstances described in this Living Will below.
In the event that I develop a condition deemed to be “terminal” and my attending physician and one other physician have both determined/agreed that there is no chance for recovery from this terminal condition, I request/direct the following:
Indicate either “Do not prolong my life using artificial life support” or “Use whatever life-prolonging procedures are available to prolong my life.”
Indicate either “Do not administer food or water artificially” or “Administer food and water artificially” or “Administer food and water artificially only to the extent necessary to provide comfort or alleviate pain, provided such administration does not have the added effect of prolonging my life artificially.”
Indicate either “Administer necessary care in order to provide comfort and alleviate pain” or “Do not administer any care intended to provide comfort or alleviate pain” or “Administer necessary care in order to provide comfort and alleviate pain to the extent that such care does not also have the effect of prolonging my life artificially.”
In the event that I fall into a coma and my attending physician and one other physician have both determined/agreed that there is no chance for recovery from this condition, I request/direct the following:
Indicate either “Do not prolong my life using artificial life support” or “Use whatever life-prolonging procedures are available to prolong my life.”
Indicate either “Do not administer food or water artificially” or “Administer food and water artificially” or “Administer food and water artificially only to the extent necessary to provide comfort or alleviate pain, provided such administration does not have the added effect of prolonging my life artificially.”
Indicate either “Administer necessary care in order to provide comfort and alleviate pain” or “Do not administer any care intended to provide comfort or alleviate pain” or “Administer necessary care in order to provide comfort and alleviate pain to the extent that such care does not also have the effect of prolonging my life artificially.”
In the event that I am in a persistent vegetative state and my attending physician and one other physician have both determined/agreed that there is no chance for recovery from this condition, I request/direct the following:
Indicate either “Do not prolong my life using artificial life support” or “Use whatever life-prolonging procedures are available to prolong my life.”
Indicate either “Do not administer food or water artificially” or “Administer food and water artificially” or “Administer food and water artificially only to the extent necessary to provide comfort or alleviate pain, provided such administration does not have the added effect of prolonging my life artificially.”
Indicate either “Administer necessary care in order to provide comfort and alleviate pain” or “Do not administer any care intended to provide comfort or alleviate pain” or “Administer necessary care in order to provide comfort and alleviate pain to the extent that such care does not also have the effect of prolonging my life artificially.”
By my signature below, in front of the witnesses identified below, I hereby execute and subscribe to the declarations made in this Living Will both freely and voluntarily, and wholeheartedly request that my family, physician(s), attorney, and any other individuals who may in the future become responsible for my health and well-being and any decisions related thereto, whether partly or fully, all abide by my wishes as stated herein.
available
Living Will Template
Used 5,241 times
AI assistant includedLife is unexpected, so you must be prepared. Use this free living will template to outline what steps you want to be taken, in worst case scenarios.
FAQ
A living will is a legally binding document which works as an advanced directive that tells medical authorities how a person wished to lead their life in case they can’t communicate as much in the future. For example, some people would like to have a DNR order in place, and others would like to live without a DNR order.
A living will shows the appropriate authorities how your end of life wishes. It is typically constructed when you are in sane mental capacity, and gives instructions on how you want your end-of-life medical treatment to be. A living will is made to have affairs in order if, in the future, you become incapacitated.
A few examples of living will are:
If you wish to be resuscitated or have a “do not resuscitate” (DNR) order.
Listing if you wish to opt out of certain medical care.
Choosing what you want to do when treatment is limited.
If you wish to use pain medication or not.
If you wish to have blood transfusions or not. Applicability of living wills differ from state to state.
Disclaimer
Parties other than PandaDoc may provide products, services, recommendations, or views on PandaDoc’s site (“Third Party Materials”). PandaDoc is not responsible for examining or evaluating such Third Party Materials, and does not provide any warranties relating to the Third Party Materials. Links to such Third Party Materials are for your convenience and does not constitute an endorsement of such Third Party Materials.