Ohio Living Will

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I. Introduction

I, [Your Name], residing at [Your Address], hereby declare this document to be my Living Will, also known as an advance directive, to express my medical treatment preferences if I become incapacitated and unable to communicate my wishes.

II. Declaration of Intent

In issuing this written document, I, with full understanding and conviction, assert that I intend to detail and provide clear and precise instructions that pertain to my personal preferences related to the receiving of medical treatment and care. This is done to remove any ambiguity or uncertainty that may arise in making decisions regarding my health, should a circumstance arise where I am not able to make or communicate those decisions myself.

III. Appointment of Healthcare Agent

If I am unable to make or communicate decisions regarding my medical treatment, I hereby appoint [Healthcare Agent Name] as my healthcare agent to make decisions on my behalf according to the instructions provided in this document.

IV. Medical Treatment Preferences

I specify the following preferences for my medical treatment:

1. End-of-Life Care:

   • If I am in a terminal condition with no reasonable expectation of recovery, I direct that life-prolonging treatments, including but not limited to:

     • Cardiopulmonary resuscitation (CPR),

     • Mechanical ventilation,

     • Artificial nutrition and hydration should be withheld or withdrawn, and I should be allowed to die naturally.

2. Palliative Care:

   • I authorize the use of palliative care and pain management measures to keep me comfortable, even if they may hasten my death.

3. Organ and Tissue Donation:

   • I express my desire to donate any viable organs or tissues for transplantation or medical research purposes, by applicable laws and regulations.

V. Additional Instructions

I provide the following additional instructions regarding my medical care:

• [Additional Instructions Placeholder]: [Insert any additional instructions or preferences here.]

VI. Revocation of Prior Documents

I, through this document, am formally removing and canceling any prior advance directives or living wills that I, the undersigned, have previously made.

VII. Execution

I declare that I have signed this Ohio Living Will on this [Date] day of [Month], [Year], at [Location], in the presence of the following witnesses, who have signed their names in my presence and at my request.

Testator

[Your Name]

[Your Address]

Witness 1

Name: [Witness Name 1]

Address: [Witness Address 1]

Witness 2

Name: [Witness Name 2]

Address: [Witness Address 2]

VIII. Notarization

On the specified date of [Date], in the presence of me, a notary public, [Your Name] made a personal appearance. Their identity was confirmed by me, either through personal knowledge or adequate evidence, to be the individual who signed the preceding document, and they confirmed that their execution of it was for the intentions stated within.

Notary Public

[Printed Name of Notary Public]
[Commission Number of Notary Public]
My Commission Expires: [Expiry Date of Notary Public's Commission]

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