New Hampshire Living Will
New Hampshire Living Will
I. Introduction
This Living Will is made on [Date] by [Your Name], residing at [Your Company Address], hereby referred to as the "Declarant," being of sound mind and body, hereby declare the following directives and instructions to be carried out in the event of my incapacity to make decisions regarding my medical treatment.
II. Declaration of Intent
I, [Your Name], hereby declare that if I am unable to communicate my wishes regarding medical treatment due to incapacity or terminal illness, I wish to have my wishes regarding medical treatment respected and followed. I understand the importance of providing clear instructions to my family, physicians, and healthcare providers to ensure that my preferences are upheld.
III. Healthcare Agent
I hereby appoint [Healthcare Agent's Name], residing at [Agent's Address], as my healthcare agent to make healthcare decisions on my behalf under my wishes as expressed in this Living Will. If my primary healthcare agent is unable or unwilling to serve, I appoint [Alternate Healthcare Agent's Name], residing at [Alternate Agent's Address], as my alternate healthcare agent.
IV. Medical Treatment Preferences
A. End-of-Life Care
I direct that, in the event of a terminal condition or irreversible coma, I do not wish to be kept alive by artificial means. Specifically, I do not wish to receive:
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Cardiopulmonary resuscitation (CPR)
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Mechanical ventilation
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Artificial nutrition and hydration (tube feeding)
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Dialysis
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Any other life-sustaining treatments that only prolong the dying process without offering a reasonable hope of recovery.
B. Comfort Measures
I request that I be provided with all necessary comfort measures to alleviate pain and suffering, even if such measures may hasten my death. This includes but is not limited to:
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Pain management
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Palliative care
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Hospice care
V. Organ Donation
I hereby authorize the donation of any needed organs, tissues, or body parts for transplantation or medical research upon my death.
VI. Revocation
I reserve the right to revoke this Living Will at any time by providing written notice to my healthcare agent and all relevant healthcare providers.
VII. Signature
In witness whereof, I have signed this Living Will on the date first above written.
Declarant
[Your Name]
[Your Company Address]
VIII. Attestation
We, the undersigned witnesses, affirm that the Declarant signed this Living Will in our presence, and we believe the Declarant to be of sound mind and under no duress or undue influence to execute this document.
Witness 1
Name: [WITNESS NAME 1]
Address: [WITNESS ADDRESS 1]
Witness 2
Name: [WITNESS NAME 2]
Address: [WITNESS ADDRESS 2]
IX. Notarization
State of New Hampshire
County of [Your County]
On this day of [Month], [Year], before me, a Notary Public in and for said County and State, personally appeared [Your Name], known to me to be the person whose name is subscribed to the foregoing instrument, and acknowledged that he/she executed the same for the purposes therein contained.
Notary Public: [NOTARY'S NAME]
My Commission Expires: [EXPIRATION DATE]
Notary Public Seal: [SEAL]
