Mississippi Living Will
This Living Will is declared by [Your Name], herein referred to as the "Declarant", currently residing at [Your Address]. This document is executed and effective as of [Effective Date] and expresses my wishes regarding my medical treatment in situations where I am no longer able to communicate my intentions directly.
I. Declaration of Understanding
1. I understand the full implications of this Living Will and I am emotionally and mentally competent to make these decisions.
2. I make these statements to ensure that my desires are fulfilled, and to alleviate any burdens on my family and physicians.
II. Health Care Directives
This Living Will applies when I am unable to express my healthcare decisions due to illness or incapacity. Should the following circumstances arise, I direct my treatments be administered as follows:
2.1 Life-Prolonging Procedures
If I suffer from a terminal condition, persistent vegetative state, or an end-stage condition, the directives are:
I [Desire/Do not desire] the use of life-prolonging treatments such as mechanical ventilators, dialysis, or surgical procedures that are only intended to prolong the process of dying.
I [Desire/Do not desire] nutrition and hydration provided to me artificially if the feeding cannot be naturally administered.
2.2 Other Medical Treatments
Use of pain relievers: I [Desire/Do not desire] to use medication to alleviate pain even if it may hasten my death.
Specific treatments wished: If my heart stops beating and I am not breathing, I request CPR to be performed if there is a reasonable chance of meaningful recovery.
III. Appointment of Health Care Proxy
I hereby designate [Proxy's Name], residing at [Proxy's Address], as my Health Care Proxy to make all necessary healthcare decisions on my behalf when I am unable to do so. This includes decisions that adhere to the instructions outlined in this document. In the absence of my primary proxy, I appoint [Alternate Proxy's Name] residing at [Alternate Proxy's Address] as my alternate Health Care Proxy.
IV. Revocation of Prior Declarations
I hereby revoke any former Living Wills or similar documents previously executed by me. This document reflects my current wishes regarding my medical care.
V. Legal Provisions
5.1 Severability: If any provision of this Living Will is deemed invalid or illegal, the remaining provisions shall remain effective and enforceable.
5.2 Binding Effect: This Living Will shall be binding upon my family, physicians, and other healthcare providers subject to its terms.
5.3 Governing Law: This document shall be governed by the laws of the State of Mississippi.
VI. Signatures and Witnesses
I sign this Living Will in the presence of the following witnesses, who sign this Will at my request, in my presence, and the presence of each other.
Declarant
[Your Name]
[Date Signed]
Witness 1
Name: [Witness 1 Name]
Address: [Witness 1 Address]
Witness 2
Name: [Witness 2 Name]
Address: [Witness 2 Address]
VII. Notary Acknowledgment
County of [County Name], State of Mississippi
On this [Date], before me, [Notary's Name], a notary public in and for the said state, personally appeared [Your Name], known to me to be the person described in and who executed the foregoing instrument, and acknowledged that he/she executed the same as his/her free act and deed.
Witness my hand and official seal.
Notary Public: [NOTARY'S NAME]
My Commission Expires: [EXPIRATION DATE]
Will Templates @ Template.net
