An Example of online Free Printable Living
Will Forms
(NOT
A LEGAL DOCUMENT! JUST AN EXAMPLE. IT'S IMPORTANT TO RESEARCH
ENOUGH
TO MAKE SURE THE ON-LINE LIVING WILL FORMS YOU WILL BE USING
COMPLY
WITH STATE LIVING WILL DOCUMENT LAWS)
[PRINT YOUR NAME]
I,
___________________________, being of sound mind, make this statement
as a
directive to be followed if I become permanently unable to participate
in
decisions regarding my medical care. These instructions reflect my firm
and
settled commitment to decline medical treatment under the circumstances
indicated below:
I
direct my attending physician to withhold or withdraw treatment that
merely
prolongs my dying, if I should be in an incurable or irreversible
mental or
physical condition with no reasonable expectation of recovery.
These
instructions apply if I am (a) in a terminal condition; (b) permanently
unconscious; or (c) if I am minimally conscious but have irreversible
brain
damage and will never regain the ability to make decisions and express
my
wishes.
I
direct that my treatment be limited to measures to keep me comfortable
and to
relieve pain, including any pain that might occur by withholding or
withdrawing
treatment.
[CROSS
OUT ANY STATEMENTS WITH WHICH YOU DO NOT AGREE]
While
I understand that I am not legally required to be specific about future
treatments if I am in the condition(s) described above I feel
especially
strongly about the following forms of treatment:
I
do not want cardiac resuscitation.
I
do not want mechanical respiration.
I
do not want artificial nutrition and hydration.
I
do not want antibiotics.
However,
I do want maximum pain relief, even if it may hasten my death.
[ADD
PERSONAL INSTRUCTIONS (IF ANY)]
Other
directions:
These
directions express my legal right to refuse treatment, under the law of
New
York.
I intend my
instructions to be carried out, unless I have rescinded them in a new
writing
or by clearly indicating that I have changed my mind.
[SIGN
AND DATE THE DOCUMENT AND PRINT YOUR ADDRESS]
Signed:
... Date: ________
Address:
...
[YOUR
WITNESSES MUST SIGN AND PRINT THEIR ADDRESSES]
I
declare that the person who signed this document is personally known to
me and
appears to be of sound mind and acting of his or her own free will. He
or she
signed (or asked another to sign for him or her) this document in my
presence.
Witness
#1:
Signed:
...
Address:
...
Witness
#2:
Signed:
...
Address:
...
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