Living Will Form | Estate Planning - Living Will

Living Wills let you determine what happens to you in end-of-life and life support systems. They are called other names in some states, like Health Care Directive. You will receive the proper Living Will form for your State.

Some States use a Living Will and others a Heath Care Directive. You will receive what your State uses.

All Living Will Forms - By State What Is A Living Will

This is a Sample Living Will. But you must obtain the form required by your State. For Illustration Purposes.


[Name of Declarant]

If I should have an incurable or irreversible condition with no hope of recovery 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, pursuant to the Common Law and the Arkansas Rights of the Terminally Ill or Permanently Unconscious Act, to withhold or withdraw treatment that only prolongs the process of dying and is not necessary to my comfort or to alleviate pain.

Additionally, if I should become permanently unconscious, I direct my attending physician, pursuant to the __________ Rights of the Terminally Ill or Permanently Unconscious Act, to withhold or withdraw life-sustaining treatments that are no longer necessary to my comfort or to alleviate pain.

Section 1: Life-Sustaining Treatments

The life-sustaining treatments which may be withheld or withdrawn are (check all that apply):

0 Cardiopulmonary Resuscitation.
0 Mechanical Breathing..
0 Major Surgery..
0 Kidney Dialysis..
0 Chemotherapy..
0 Minor Surgery (unless necessary for my comfort or to alleviate pain)..
0 Invasive Diagnostic Tests..
0 Antibiotics..
0 Blood Products..
0 Other Medications not Necessary for Alleviation of Pain.

Add other medical directives, if any: _______________________________..

Section 2: Artificial Nutrition and Hydration

I understand that Arkansas law requires me to make my wishes regarding artificial nutrition and hydration known separately from the above directions. Therefore, by initialing the appropriate line(s) below, I specifically:

________ DIRECT that artificial nutrition may be withheld or withdrawn after consultation with my attending physician..
________ DIRECT that artificial hydration may be withheld or withdrawn after consultation with my attending physician. .

SIGNED this ________ day of _______________________________ 20________.

________________________________________ .

We, the undersigned, do hereby certify that the Declarant, _______________________________ subscribed this Declaration of Living Will in our presence, and we, at his or her request, in his or her presence, and in the presence of each other, signed as attesting witnesses, and we do further certify that the Declarant appeared to be eighteen years of age or older, of sound mind, and acting without undue influence, fraud or restraint and that his or her signature was voluntary.

Witness .
Witness .

Remainder of Form Omitted

What is a Living Will and Why Does One Really Matter? Living Will Form

The legal and emotional battles the family of patient Terry Schiavo endured over her end-of-life decisions and removing her life support systems made national headlines. If you know how to make a living will, you can save your loved ones such expense and trauma. We don't like to think about such events, but taking the time now to express your preferences for medical care and life support can ensure that your loved ones will not be burdened with making difficult medical decisions on their own or through the courts. Living wills may be easily prepared without an attorney. A living will sample may also be followed for guidance.

What is a Probate Estate? Living Will Template

Although the term living will may sound like a last will, it doesn't have anything to do with how to avoid probate of your estate or distribution of your assets to heirs. Therefore, don't let the title of an advance healthcare directive form fool you. Originally, an advance directive form was only used to express your wishes regarding healthcare decisions when you are permanently unconscious or have a terminal illness. Later, what are sometimes referred to as second generation advance directives or third generation advance directives, were developed to allow a person to appoint another in advance to act as their healthcare agent when he or she is incapacitated. It is intended to provide instructions for others to make medical care decisions for you when you are no longer able to make medical decisions for yourself. A healthcare agent, sometimes called a health care proxy, patient advocate, surrogate, or health care representative, may also be appointed in advance to make medical care decisions when you are not able to make decisions and healthcare choices for yourself.

How to Make a Living Will How To Make A Living Will

A living will form may be provided to your physician and other healthcare providers, allowing them to follow your wishes for medical care. The form states whether you wish your life to be artificially prolonged if you are a patient with a catastrophic illness or accident. The form must comply with the laws of your state, since the laws vary by state. A form for a living will may require two witnesses to attest to your signature and/or that the form be notarized. The form for living will provided on this site will indicate which is required.

When living wills are combined with the appointment of a healthcare agent, they are often referred to as advance directives for medical care. If the advance healthcare directive provides for the appointment of an agent to make care and treatment decisions, the agent should not also serve as a witness. Many forms also allow you to appoint a successor health care proxy in case the first health care agent is no longer able to serve. The person you select as your agent should be someone you trust and doesn't need to be a family member. The representative should be someone who understands and shares your values and lives in your area.

Living wills may also be used to express your wishes for organ donations and final arrangements. You may use an example of a living will form for your state, or you may download a statutory living will form that copies statutory language in state statutes. Both types of living will forms are equally valid, since the forms and living will samples offered by USLegal are state-specific and all of our advance medical directive forms are regularly updated to comply with state law. Be aware that many sites offering a living will sample offer the same advance directive form for all states, whether you need a California living will, Florida living will, or Texas living will, etc. If the advance healthcare directive doesn't comply with the laws of your particular state, it will not be enforceable.

A healthcare power of attorney or other medical directive doesn't take effect until a medical expert determines you are permanently unconscious. An advance directive form may be freely revoked while you are still competent and not incapacitated. A copy of your advance medical directive form should be provided to any healthcare agent you appoint, your doctor and other healthcare providers, and any close friends and relatives whose cooperation may be needed. Some states also have a living will registry for living wills and other advance health care directives.

Medical Treatment Options for You to Decide Upon A Living Will

When you make an advance directive for healthcare or form for living will, you will need to make medical care decisions in advance. The following are some of the medical treatment options and healthcare decisions you should consider if you were to become hospitalized in a persistent vegetative state:

Cardiopulmonary resuscitation (CPR) is a method of reviving a patient's heart by a device that delivers an electric shock to stimulate a heart that has stopped beating.

Artificial ventilation is a procedure for providing oxygen to you through mechanical means when you are unable to breathe on your own.

Artificial nutrition and hydration provides fluid and nutrition through intravenous means or a tube when the patient is unable to be fed.

Dialysis cleans your blood and maintains proper fluid levels when your kidneys fail.

Pain medication can ease discomfort for a patient but may affect awareness of surroundings.

Other Advance Directives Living Will Sample

Some other forms individuals may use to give advance instructions to make healthcare decisions on their behalf and state medical treatment preferences include:

  • Do-Not-Resuscitate Order (DNR)- this form states your preference not to be resuscitated and instructs healthcare providers not to use CPR if your heart stops beating.
  • Mental Health Care Directive - the patient may state treatment preferences for mental healthcare, such as consent to psychoactive medication, electroshock therapy, restraint, isolation, or medication in this advance directive.

Conclusion Florida Living Will Form

You can save your loved ones much additional trauma in an already difficult situation by creating advance directives for medical decisions or a living will. By taking the time to complete a form for a living will, you can have the peace of mind of knowing that your wishes for medical treatment and life-prolonging procedures will be followed and that those closest to you will be spared from having to make difficult medical care decisions. Feel free to contact US Legal Forms with any questions you may have regarding our Living Will template.

Living Will FAQ Pennsylvania Living Will Form

What is the Role of the Health Care Agent in a Living Will?

Q: What duties does my healthcare surrogate have?

A: The health care representative you choose will act for you in regard to medical decisions when you are incapacitated and unable to make decisions or unable to speak for yourself, such as when you are permanently unconscious or in a vegetative state. You may create an advance medical directive with instructions for the agent to follow your wishes regarding such medical treatments as artificial nutrition and hydration and other life support procedures.

Can a Living Will Form for One State Be Used in Another State if You Move?

Q: I made a living will here in New York, but now I will be moving to California. Do I need to make an advance directive using a California form?

A :It is recommended to create a living will that complies with the law where you reside. Although it is possible for a court to recognize a healthcare directive that complies with the law of the state where it was executed, having a living will document that complies with the state of residence can minimize the possibility of conflicts, confusion, and delays caused by need for legal interpretations.

Can Living Wills Be Changed or Revoked?

Q: What happens if my healthcare agent changes or I need to make a new advance directive in another state?

A: An advance directive or designation of a medical care surrogate may be amended or revoked at any time by a competent principal by a signed writing or a new advance directive, according to the applicable state laws.

Some states have a living will registry, so if you had filed a previous document, a revocation of living will document may be created, and if applicable, filed with the registry where the original directive was filed. Applicable local law should be consulted. A new living will or advance directive should also state that any previous ones are revoked.

Many of the medical power of attorney and advance directive forms we offer allow you to also name a successor agent in the event the original appointee becomes unavailable due to death, resignation, etc.

Can More Than One Agent Be Appointed in a Living Will?

Q: I am wondering if I can use one of your living will samples to name both of my sisters as my health care proxy?

A: While some states may allow you to name co-agents, it's not advisable to do so, as this may create conflicts over your care decisions. However, it is possible to name a successor agent to take over and make medical decisions for you if the original health care representative becomes unavailable or unwilling to serve for any reason.

What Do I Need to Do With the Living Will Form After I Execute It?

Q: After I fill out the sample forĀ a living will, do I need to file it at court?

A: It's not required to be on file at the courthouse, however, some states have created living will registries. A copy of advance directives for medical care should be given to the health care proxy you appoint, as well as your health care providers.

What Is The Difference Between A Will And A Living Will?

Q: Could you please explain how a last will and testament is different from a living will?

A: A last will deals with how to distribute your estate and settle your debts and affairs after your death. A living will or other advance health care directive deals with how to make health care decisions for you while you are still alive but unable to speak for yourself. A medical care power of attorney can appoint a health care proxy to make medical care decisions according to the instructions in your living will form.

Why a Living Will is Essential

Why Delaying a Living Will is a Huge Mistake

Why You Need a Living Will

Can a Living Will Prevent a Life and Death Battle?

Pregnancy & Your Living Will

Munuz Case Update

Gold Award 2006-2018

BEST Legal Forms Company

11 Year Winner in all Categories:
Forms, Features, Customer Service
and Ease of Use.

U.S. Legal Forms, Inc. BBB Business Review

Your Satisfaction Guarantee

Our Customers Believe! Living Will Forms

"You have an excellent service and I will be sure to pass the word."