» Living Will Forms (Advance Directives)

Living Will Forms (Advance Directives)

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A living will, often referred to as an ‘Advance Directive’ when combined with a medical power of attorney, lets a patient, known as the ‘principal’, be able to make their end-of-life treatment instructions for medical staff. Also described as a Declaration as it typically written to establish that the patient is not interested in any life-support when they are considered medically to be in an incurable state. This allows doctors to discontinue artificial feeding and breathing and allows the patient to die a natural death.

This is unlike power of attorney that allows the patient to choose a surrogate to handle all their treatment options if and when they cannot.

By State

Living Will vs Medical POA

Living Will – Declaration made to physicians that states a patient’s instructions in the chance they are in a permanent vegetative state in relation to end of life procedures.

Medical Power of Attorney – Allows a surrogate to handle all decisions on your health care related decisions.

Laws By State

How to Write

It should be known that this document is structured as an ‘Advance Directive’ meaning it contains both a living will and medical power of attorney. If the individual would not like to elect a person to make health care decisions on their behalf in the power of attorney they may write in the blank field ‘NONE’ and Part II of the document shall be considered invalid.

Step 1 – After reading the introduction and fully understanding it’s function and use write the date it will will be completed and signed by the principal.

Step 2 – Enter the principal’s personal details including:

  • Full name;
  • Street address including County and State;
  • Last four (4) digits of their Social Security Number (SSN).

Step 3 – The Principal may choose to have life support withdrawn if one, some, or all of the conditions apply by initialing and checking the appropriate box:

  • Coma and/or persistent vegetative state;
  • Not able to communicate needs;
  • Not able to recognize family or friends;
  • Total dependence on other for daily care;
  • Other description as defined by the Principal (write-in).

Step 4 – On the next two (2) sections only initial and check one (1) of the options to elect on having food water fed to the principal intravenously (IV).

Step 5 – Select whether to elect having the following life-sustaining treatment options by initialing and checking the box:

  • Cardiopulmonary Resuscitation (CPR);
  • Ventilation (breathing machine);
  • Feeding tube;
  • Dialysis;
  • Other – Write yourself.

Step 6 – In Section C, enter any end of life wishes that you may desire. Part I of the document, the living will, is now complete.

Step 7 – In Part II of the document the Principal may choose to select up to two (2) health care agents to make decisions on your behalf for medical matters. In the first (1st) section, enter your name and the name of the agent you would like to have represent your best interests.

Step 8 – Below the first (1st) paragraph write the agent’s street address and telephone number (preferably cell phone).

In the section underneath enter a secondary (2nd) agent in the chance the first (1st) cannot make it. Enter the secondary (2nd) agent’s address and telephone number.

Step 9 – The principal should sign the form while entering their street address and telephone number. The signature must be witnessed by either:

  • Two (2) individuals who have no relation to the Principal (by blood or marriage) and cannot be medical staff.
  • Notary Public that is licensed in the State of the Principal.

After the form is complete is should be distributed to the Principal’s primary care physician, family, and friends to ensure that a copy is provided in the need for the document.

 


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