Louisiana Living Will
Louisiana Living Will
I. Introduction
This Living Will document is made on [Date] by and between [Your Name], residing at [Your Address], referred to as the "Declarant," of sound mind and legal capacity.
II. Declaration of Intent
I, [Your Name], being of sound mind, hereby declare this document to be my living will, expressing my desires and wishes regarding medical treatment and end-of-life decisions if I am unable to communicate my wishes directly.
III. Health Care Proxy
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I appoint [Health Care Agent's Name], residing at [Agent's Address], as my Health Care Agent to make health care decisions on my behalf if I am unable to do so.
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If my primary Health Care Agent is unable, unwilling, or unavailable to serve, then I appoint [Secondary Health Care Agent's Name], residing at [Agent's Address], as my alternate Health Care Agent.
IV. Directions Regarding Life-Sustaining Treatment
If I am unable to communicate my healthcare decisions, and I am in a medical condition specified below, I direct that:
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If I am in a terminal condition, I request withholding or withdrawal of all treatments that would only prolong the dying process and request that life-sustaining measures be withheld or withdrawn.
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If I am in a state of permanent unconsciousness, and there is no reasonable expectation of my recovery, life-sustaining measures should be withheld or withdrawn.
V. Additional Provisions and Instructions
Even if the choices are to withhold or withdraw treatment in other circumstances, I further specify the following:
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Pain relief medication should always be provided as needed to ensure my comfort, even if it hastens my death.
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I do not wish to receive artificial nutrition and hydration if the burdens of the treatment outweigh the expected benefits.
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My healthcare agent shall have the authority to make decisions about autopsy, organ donation, and disposition of my body.
VI. Duration
This declaration remains valid and in force unless and until I revoke it.
VII. Signature and Witnesses
I sign this Living Will on [Date] in the presence of the following witnesses, who also sign in my presence.
Declarant
[Your Name]
Witness 1
Name: [Witness 1 Name]
Address: [Witness 1 Address]
Witness 2
Name: [Witness 2 Name]
Address: [Witness 2 Address]
VIII. Notary Acknowledgment
Parish of [Parish Name], State of Louisiana
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]
