Maine Living Will
Maine Living Will
This document declares the healthcare preferences and end-of-life decisions of [Your Name], hereafter referred to as "the Declarant," and becomes effective if the Declarant becomes incapacitated and unable to communicate their wishes.
I. Declaration
I, [Your Name], resident in [Your Address], being of sound mind, do hereby willfully and voluntarily declare my desire that my dying shall not be artificially prolonged under the circumstances set forth below, and I affirm this declaration reflects my firm and settled commitment to decline life-sustaining treatment under these circumstances.
II. Effective Date
This Living Will shall become effective upon the Declarant’s inability to communicate healthcare decisions due to medical incapacity, as determined by a licensed physician.
III. Healthcare Directives
My healthcare preferences, to be followed by any physician, healthcare provider, or individual appointed to make decisions on my behalf, are as follows:
3.1 Life-Sustaining Treatment
If I am in a terminal condition, I [do/do not] want life-sustaining treatment to be provided or continued. This includes treatments that could keep me alive but do not cure me.
3.2 Artificial Nutrition and Hydration
I [do/do not] want artificial nutrition (feeding tube) and hydration (IV fluids) if I am unable to eat or drink on my own.
3.3 Pain and Comfort Measures
Regardless of my other directives, I want measures taken to keep me comfortable and to relieve pain, including any pain-relieving drugs or other measures.
IV. Preferences in Other Medical Conditions
In any situation where I am unable to communicate my preferences, such as irreversible coma or persistent vegetative state:
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I [do/do not] want my life to be prolonged through medical interventions.
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I [do/do not] want resuscitation if my heart and/or breathing stops.
V. Healthcare Agent
I designate the following individual as my Healthcare Agent, who is authorized to make healthcare decisions on my behalf, under my wishes and best interests, and according to this document when I am unable to make my decisions known:
Name: [Healthcare Agent Name]
Address: [Healthcare Agent Address]
Phone Number: [Healthcare Phone Number]
VI. Signature and Witnesses
I affirm that this Living Will expresses my desires regarding medical treatment and end-of-life care.
[Your Name]
[Date Signed]
Witness 1
Name: [Witness 1 Name]
Address: [Witness 1 Address]
Date: [Date Signed]
Witness 2
Name: [Witness 1 Name]
Address: [Witness 1 Address]
Date: [Date Signed]
VIII. Notary Acknowledgment
County of [County Name], State of Maine
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]
