Living Will Declaration
This Living Will is made in accordance with the laws of [State Name].
I, [Your Full Name], born on [Your Date of Birth], residing at [Your Address], hereby declare this Living Will.
If I become unable to make my own decisions regarding medical treatment due to illness or injury, I provide the following instructions:
- End-of-Life Care:
- If I am in a terminal condition and unable to make decisions, I do not wish to receive life-sustaining treatment that would only prolong the dying process.
- If I am in a persistent vegetative state with no reasonable chance of recovery, I do not wish to receive artificial nutrition and hydration.
- Health Care Proxy:
- I appoint [Proxy's Full Name], residing at [Proxy's Address], as my health care proxy. If they are unavailable, I appoint [Alternate Proxy's Full Name], residing at [Alternate Proxy's Address].
- Additional Instructions:
- [Any additional preferences, wishes, or instructions regarding health care]
By signing below, I indicate that I understand the importance of this document and that it reflects my wishes concerning my health care.
Signed: _______________________ (Signature)
Date: ________________________
Witnessed by:
1. _______________________ (Signature) – [Print Name]
2. _______________________ (Signature) – [Print Name]