Kentucky Living Will

I. Introduction

This living will document is prepared by [Your Name], a resident of [Your Address], to express my wishes regarding medical treatment if I am unable to communicate my decisions due to incapacity.

II. Declaration of Intent

I, [Your Name], being of sound mind and body, hereby declare this to be my living will. This document reflects my desires concerning medical care and treatment if I am unable to participate in medical treatment decisions.

III. Health Care Agent

A. Appointment of Health Care Agent

I appoint [Your Health Care Agent], residing at [Health Care Agent Address] as my health care agent to make medical decisions on my behalf should I become incapacitated.

B. Successor Health Care Agent

If my primary agent is unable or unwilling to serve, I appoint [Successor Health Care Agent] residing at [Successor Health Care Agent Address] as my successor agent.

IV. Health Care Instructions

If I am unable to make or communicate my own healthcare decisions, I provide the following instructions:

A. End-of-Life Care

• Prolonging Life: If I am in a terminal condition with no reasonable expectation of recovery, I do not wish to be kept alive through artificial means such as life support or CPR.

• Comfort Care: I request palliative care and pain relief measures even if they might hasten my death.

B. Specific Treatments

• Tube Feeding: I [do/do not] consent to tube feeding if I am unable to eat or drink.

• Dialysis: I [do/do not] consent to dialysis if my kidneys fail.

• Antibiotics: I [do/do not] consent to antibiotic treatment for infections.

C. Organ Donation

• Organ Donation: I [consent/do not consent] to organ donation for transplantation purposes.

V. Additional Provisions

1. Revocation: I reserve the right to revoke or amend this living will at any time.

2. Acknowledgment: I affirm that I am signing this document voluntarily and understand its contents.

VI. Signature and Witnesses

I sign this Living Will on [Date] in the presence of the following witnesses who attest to my signing willingly and voluntarily.

[Your Name]

Witness 1

Name: [Witness 1 Name]

Address: [Witness 1 Address]

Witness 2

Name: [Witness 2 Name]

Address: [Witness 2 Address]

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VII. Notary Acknowledgment

County of [County Name], State of Kentucky

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]

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