Alaska Living Will
Alaska Living Will
This Alaska Living Will is a legal document that allows [Your Name] (also referred to herein as “the declarant”) to outline their preferences concerning medical treatment and end-of-life care. This document ensures that the declarant's medical care wishes are respected and carried out when they are unable to communicate these wishes themselves.
I. Declaration
I, [Your Name], residing at [Your Company Address], being of sound mind and not being under duress, fraud, or undue influence, do hereby declare this document as my Living Will. This document reflects my wishes regarding my healthcare and medical treatment in instances where I am incapable of making or communicating my medical decisions.
II. Appointment of Health Care Representative
I appoint [Representative's Name], currently residing at [Representative's Address], as my Health Care Representative. I grant them full authority to make decisions about my medical care, including decisions about withholding or withdrawing treatment, when I am unable to do so myself.
Contact information of Health Care Representative:
-
Phone: [Your Company Number]
-
Email: [Your Company Email]
III. General Instructions for Health Care
I desire my healthcare providers to follow these general rules if I am in the condition described below:
-
In the event of a terminal condition where the prognosis is deemed incurable and death is imminent, I request that medical care focus on providing comfort and alleviating pain. This includes measures such as pain management, hospice care, and emotional support. I do not wish to undergo any invasive or burdensome life-sustaining treatments that prolong the dying process without offering meaningful benefits to my quality of life.
-
In the event of irreversible unconsciousness where there is no reasonable expectation of recovery or meaningful consciousness, I do not wish to receive cardiopulmonary resuscitation (CPR). I understand that CPR may cause undue suffering and offer little chance of restoring consciousness or improving my condition.
-
Similarly, I do not wish to be placed on mechanical ventilation or life-support machines if I am in a permanent unconscious state. I prefer a natural end-of-life process and request that life-sustaining treatments be withheld or withdrawn in such circumstances.
IV. Organ Donation
I [do/ do not] wish to donate my organs, tissues, and eyes for transplantation or medical research purposes upon my death.
Specific Organ Donation Instructions:
[Include any specific instructions regarding organ donation]
V. 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]
VI. Notary Acknowledgment
County of [County Name], State of Alaska
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]
