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Living Will Declaration

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living will declaration 

Living Will Declaration

File Type: Word        Price: $7.99          Add Living Will To Cart:


Summary: A properly executed Living Will Declaration acts as an expression of an individual's right to refuse medical treatment if he/she is unable to give direction regarding the use of life-sustaining treatment due to a terminal condition or permanently unconscious state. This voluntary living will statement makes known the individual's desire that death not be artificially prolonged. A living will declaration helps resolve any disputes amongst family as to your wishes regarding life support; you wishes are clearly articulated in the living will declaration agreeement.


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      This Declaration is made as follows:

      If the time comes when I can no longer take part in making decisions for my own future, let this statement stand as an expression of my wishes and my declaration while I am of sound mind.

      I, __________________, (the "Declarant"), being of sound mind, having reached the age of eighteen (18) years, residing in the State of __________, do hereby make, publish and declare the following:

      1. If I should have an incurable or irreversible condition that will cause my death within a relatively short time, and I am no longer able to make decisions regarding my medical treatment, I direct my attending physician to withhold or withdraw treatment that only prolongs the process of dying and is not necessary to my comfort or to alleviate pain.

      2.  If I should become permanently unconscious, I direct my attending physician to withhold or withdraw life-sustaining treatments which are no longer necessary to my comfort or to alleviate pain.

      These life-sustaining treatments which may be withheld or withdrawn include, but are not limited to:


                   Artificially Administered Feeding & Fluids

                   Cardiac Resuscitation

                   Respiratory Support


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