Complete this free living will form according to your preferences
and know that it will stand as your wish in a medical crisis.
It should always be your choice!
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 living will template supplied here.
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.
Incidentally, if a doctor has a conscientious objection to withold treatment as per a living will, he/she is not obliged to do so, but may be replaced by another doctor.
There's one instruction, or rather directive, that warrants a special mention and careful consideration...
There are a number of reasons why one may want to add a DNR (i.e. not to institute CPR or to withdraw CPR) as a clause to a living will.
For example, where a patient is suffering from a terminal disease, in an end-stage condition or in a persistant vegetative state.
In the living will this is expressed as your advance directive (not a legal order) and serves to guide and inform family and doctors when you are in a medical state with no chance of recovery and you are also no longer able to make medical decisions.
This must be discussed with the senior clinician in charge of a patient and added to a patient's medical notes to give this order a chance of being honored. If the patient is in hospice or a medical care facility, this legal notice to allow natural death will typically be prominently displayed in the patient's room.
The DNR Order itself can only ever be a physician's order - duly signed by the physician and patient (or patient's appointed representative) - so emergency or attending medical personnel will know that they may withold CPR (cardiopulmonary resuscitation) if a patient's heart stops beating or the patient stops breathing, without fear of liability or criminal prosecution.
We use the terms living will or advance health directive interchangeably. Some jurisdictions have a preference for one or the other term but they refer to the same legal document.
It is important to refer to our Free Living Will page for more information and guidelines on compiling your document.
You can also appoint an Agent in a seperate Medical Power of Attorney. (This cannot be done on our free living will form.) He/she can then make decisions about your personal care or medical decisions on your behalf.
Note: Any such decisions made must be according to your living will or health directive.
So many of us have digital accounts such as Facebook, Instagram, eMail, Twitter etc. You would not want your logins or details to become public knowledge (as is the case with a Last Will).
We are making it easy to leave detailed instructions to your executor on how you want your accounts to be finalised when you pass away.
These instructions will only be made reference to in your Will - we will show you how to do that - without the details being disclosed in your Last Will and Testament.
Visit our EndExec page to register your email address and get advance notice when we launch our APP!
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.
1. 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 this location __________________________ 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 this location _________________________________.
You can add more numbered paragraphs to this free living will form and issue detailed instructions on whether you do or do not want:
...or any other treatment or nutrition according to your beliefs.
Note: Do you also have a Last Will and Testament in place? Refer to the information on this page: How to Write a Will where you can find links to a variety of free legal will forms and other estate information.
Note:Once you've edited and duly signed this free living will form, it is advisable to inform your next of kin or loved ones of its existence and have a copy of your living will easily accessible - especially if you directed that your organs may be used for transplant where every minute counts.
You are here: