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 Will Forms

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The life-sustaining treatments which may be withheld or withdrawn are (check all that apply):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________ DIRECT that artificial nutrition may be withheld or withdrawn after consultation with my attending physician..
________ DIRECT that artificial hydration may be withheld or withdrawn after consultation with my attending physician.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/Health Care Directive? I Need A Living Will

As a part of your end-of-life planning, you must specify your preferences for medical treatment in advance and sign a living will. A living will, or an advance healthcare directive is a legal document outlining an individual's medical treatment. It specifies treatment they prefer to receive in the case of comatose, unconsiousness, or other health conditions that would prevent them from making such decisions independently.

The document provides guidance to medical staff if there is no reasonable chance of recovery. A typical example of living will instructions is when someone agrees or refuses to be on a life support machine. In the absence of the directive, doctors act as instructed by the patient’s relatives. If you don’t want your relatives to make those difficult decisions, you can create and sign a healthcare directive.

Why Do I Need a Living Will? Living Wills

Having a signed living will enables you to receive your preferred treatment if you cannot speak for yourself due to terminal health conditions or permanent unconsciousness. People usually sign a living will when they don’t want the burden of medical decisions to rest on the shoulders of their family members. A living will includes directions on healthcare decisions – like having life-prolonging procedures or your preferred pain management interventions.

How Can I Create a Living Will? In Living Will Form

Even with the importance of this document, many people don’t know how to make a living will. Living will forms differ from state to state and are revised regularly. You may find an updated state-specific living will template on the US Legal Forms website. This type of document typically includes the following information:

  • Declarant’s full name;
  • Declarant’s address;
  • Declarant’s social security number;
  • Defining an unacceptable quality of life which may include: a chronic coma or persistent vegetative, state, inability to communicate one’s needs, bnability to recognize family and friends, total dependence on others for daily care, other conditions;
  • Declaration of desired/undesired life-sustaining treatment, e.g., ventilation, dialysis;
  • Directive execution that includes the formal signature date, printed name, and signature.

Once you have a living will form, you can convey your medical decisions in the document and have it signed. It is also required for the document to be signed by two witnesses who declare you are signing it in sound mind and at your own choice. Your doctors or employees of your healthcare providers cannot be the witnesses. State laws may require that at least one of the witnesses is not a relative. We recommend you learn about the requirements of your state regarding medical directives.

Medical Treatment Options for You to Decide Upon Living Will Example

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:

  • 1. 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.
  • 2. Artificial ventilation is a procedure for providing oxygen to you through mechanical means when you are unable to breathe on your own.
  • 3. Artificial nutrition and hydration provides fluid and nutrition through intravenous means or a tube when the patient is unable to be fed.
  • 4. Dialysis cleans your blood and maintains proper fluid levels when your kidneys fail.
  • 5. Pain medication can ease discomfort for a patient but may affect awareness of surroundings.

Other Advance Directives What Is Advance Directive

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

  • 1. 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.
  • 2. 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.

What is the Difference between a Living Will, a Last Will, and a Medical Power of Attorney? 5 Wishes Living Will

Power of attorney, living will, last will and testament are very different documents though commonly confused. While the living will gives instructions regarding medical treatment, the last will deals with the property ownership rights after death. A living will is sometimes confused with medical power of attorney. Apart from making your medical treatment decisions in advance, you can sign a medical power of attorney form to appoint a person (an agent) to make your healthcare decisions and speak on your behalf if/when you are unable to do so. To sum up:

  • 1. Living Will – specify what medical treatment you agree or refuse to receive if permanently incapacitated.
  • 2. Last Will – declare who receives your property after your death.
  • 3. Medical Power of Attorney – give the right to a specific person (who may or may not be a close relative) to decide on your treatment.

Living Will FAQ West Virginia Living Will Form

Can you write a living will without a lawyer? Living Will Pennsylvania

Yes, you can create and sign a living will without hiring a lawyer. Download a state-specific template and complete it by indicating your medical treatment preferences. There is no legal requirement that a lawyer signs your advance healthcare directive.

Does a living will need to be notarized? Wills And Living Trusts

Depending on the state you live in, you may need your living will to be notarized by a notary public. Typically, it is required to sign a healthcare directive in the presence of a notary. In some states, two witnesses are required for the document to be legally binding. Check the requirements for your state to make a legally-binding healthcare directive.

How many copies of a living will do I need? South Dakota Living Will Form

It is essential to make several copies of a living will so that all parties concerned have access to it. A patient’s doctor, a representative with power of attorney, and immediate family members should all have copies of the document to ensure the treatment according to the preferences outlined in it.

What happens if I don’t have a living will? Living Will Document

People who become permanently incapacitated but have not previously signed a living will receive treatment based on the decisions made by their closest relatives. When two doctors agree that a patient is permanently unconscious or terminally ill and therefore unable to make decisions, then the patient’s ​​next of kin has the final say on medical decisions. For example, whether or not to keep them on a life support machine. When there is a legally-binding healthcare directive, on the other hand, doctors follow what is in the document without the need to consult the patient’s relatives

Can a living will be changed or revoked? Living Will Registry

Yes, you can formally revoke your existing living will at any time and change your healthcare directive by signing a new document if you choose to. The revocation process may differ from state to state. Typically it is required to inform your healthcare provider to revoke healthcare directives.

Can a living will form for one state be used in others? Pennsylvania Living Will Form

In most cases, hospitals follow advance directives even if patients’ living wills were created outside the state where the medical services are provided. However, if you spend a lot of time in more than one state, review the rules and requirements for healthcare directives in those states. If the states have different laws regarding the issue, you should make sure you have separate documents for each state you reside in or frequently visit./p>

How to use US Legal Forms living wills? Montana Living Will Form

US Legal Forms is an extensive online library of state-specific legal templates. Choose your state, select the form name, and then click the Buy now button to download the form. You can also find a complete personal planning package that contains such document samples as a last will, a living will, a power of attorney, and others.

Once you download a living will PDF or Word document from the US Legal Forms website, you are free to fill out the file, print it, or sign it electronically. Some states don’t use the term “living will” but refer to the same type of document as a healthcare directive or simply “directive.”

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