Massachusetts Living Will
Massachusetts Living Will
I. Introduction
I, [Your Name], residing at [Your Address], being of sound mind and not being under the influence of any undue influence, do hereby declare this document as my Living Will. This Living Will reflects my wishes regarding medical treatment if I become incapacitated or unable to communicate my desires.
II. Health Care Directive
If I am unable to communicate my wishes due to incapacity or illness, I hereby declare my health care preferences as follows:
2.1 End-of-Life Care
(a) I direct that if I am diagnosed with a terminal condition by two physicians and if the application of life-sustaining treatment would only artificially prolong the process of my dying, I do not want my life to be prolonged by such treatment.
(b) I request that all treatments, including nutrition and hydration, be withdrawn or withheld if they will only serve to delay the moment of my death and are not necessary for my comfort.
2.2 Comfort Measures
I authorize the administration of pain relief medication even if it hastens my death, provided the intention is to relieve suffering.
2.3 Decision-Making Authority
I authorize my Health Care Agent to make health care decisions for me if I am unable to communicate my wishes.
2.4 Organ Donation
I hereby express my desire to donate any needed organs and tissues upon my death.
III. Health Care Agent
I appoint [Health Care Agent Name] of [Health Care Agent Address] as my Health Care Agent. If the person named is unable or unwilling to serve, I appoint [Alternate Health Care Agent Name] of [Alternate Health Care Agent Address] as my alternate.
IV. Signature and Witnesses
I affirm that this Living Will expresses my desires regarding medical treatment and end-of-life care.
[Your Name]
[Date]
Witness 1
Name: [Witness 1 Name]
Address: [Witness 1 Address]
Witness 2
Name: [Witness 2 Name]
Address: [Witness 2 Address]
V. Notary Acknowledgment
County of [County Name], State of Massachusetts
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]
