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Free Living Will Form

It should always be your choice!

Complete this free living will form according to your preferences and know that it will stand as your wish in a medical crisis.

free living will form

 

It is easiest to copy the whole document into a word editing program and then deleting the options which you do not want from the free living will form. You can add any other instructions - as long as they are not against the law and clearly convey your meaning, they must be honored by an attending physician.

For more information on compiling a living will or advance health directive, please click here.

You can also appoint an Agent in a Medical Power of Attorney. He/she can then make medical decisions on your behalf, according to your living will or make decisions about your personal care.

 

Health Care Directive (Living Will)

This directive is made by me _______________________________

Identification / Social Security Number _________________________________

at a time when I am of sound mind and after careful consideration.

If the time comes when I can no longer take part in decisions for my own future, let this Directive stand as testament to my wishes.

1.    I do not want my life prolonged by artificial means if:

a. There is no reasonable prospect of my recovery from physical illness.

b. If impairment is expected to cause me severe distress.

c. If I am rendered incapable of rational existence.

OR

I want my life prolonged as long as possible within acceptable medical practice and standards.

 

2.    I direct that I receive whatever quantity of medication that may be required to keep me from pain and distress even if the moment of death is hastened.

 

This directive is signed by me on this ________________day of _______________20____ at __________________________ in the presence of the two undersigned witnesses.

Declaration of Witnesses

As witnesses we declare that the above named person is personally known to us, appears to be of sound mind and signed this directive willingly and free of undue influence or duress. We are legal adults and are not related to him / her by blood, marriage or adoption and are not appointed as agents in this directive. To our knowledge we are not beneficiaries of his / her estate and have no claims against his / her estate. We are not directly involved in his / her health care. We declare that he / she signed this will in our presence as we signed as witnesses in the presence of each other, all being present at the same time. Under penalty of perjury we declare these statements to be true and correct on this ___________________ day of ____________________ 20____ at _________________________________.

Witness 1.    

Name: ______________________

Address: _____________________________________________

Signature: ________________________

Witness 2.    

Name: ______________________

Address: _____________________________________________

Signature: ________________________

 

You can add more numbered paragraphs to this free living will form and issue detailed instructions on whether you do or do not want:


Artificial nutrition and hydration

Blood transfusions

Abortion and/or sterilization

Transplantation

Donation of any or all organs, tissue or your remains for transplants, research or education

or any other treatment or nutrition according to your beliefs.

 

Do you also have a legal will in place? Refer to the information on How to Write a Will where you can find links to a free will form and other estate information.

 

Return from Free Living Will Form to Free Legal Documents

 

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It is advisable to have a copy of your living will close by, especially if you directed that your organs may be used for transplant.

 

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