Free Statutory Living Will Declaration Template
Statutory Living Will Declaration
I. Declaration Statement
I, [YOUR NAME], residing at [YOUR ADDRESS], born on [YOUR DATE OF BIRTH], being of sound mind, do hereby voluntarily make, declare, and publish this Living Will. It is my desire that my healthcare wishes be honoured by my family, physicians, and all concerned parties should I become unable to participate in decisions about my medical care. To all who read this living will, this document serves as a testament of my intentions and supersedes any previous documents.
II. Terminal Illness Declaration
In the unfortunate event that the Declarant is diagnosed with a terminal illness, defined as an incurable condition with a prognosis of six months or less to live, the Declarant hereby makes the following declarations and directives regarding their end-of-life care:
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Treatment Preferences: The Declarant requests that healthcare providers prioritize comfort and quality of life over aggressive medical interventions. The Declarant prefers palliative care measures aimed at relieving pain and discomfort rather than life-prolonging treatments that may cause undue suffering.
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Life-Sustaining Treatments: The Declarant expressly states their desire to forego any life-sustaining treatments, including but not limited to mechanical ventilation, artificial nutrition and hydration, and cardiopulmonary resuscitation (CPR), if such treatments would only serve to prolong the dying process without offering any realistic hope of recovery or improvement in quality of life.
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End-of-Life Decisions: In the event that the Declarant becomes incapacitated and unable to communicate their wishes, the Declarant designates [AUTHORIZED REPRESENTATIVE'S FULL NAME], residing at [REPRESENTATIVE'S ADDRESS], as their healthcare agent and authorizes said representative to make medical decisions on their behalf in accordance with the directives outlined in this Declaration.
III. Statement of Compliance
The Declarant affirms that this Declaration complies with all applicable laws and regulations governing end-of-life care directives in the jurisdiction of residence.
IV. Assurance of Quality
The Declarant assures that the directives outlined in this Declaration reflect their genuine wishes and preferences regarding end-of-life care, based on careful consideration of their values, beliefs, and personal circumstances.
V. Environmental and Social Responsibility
The Declarant acknowledges the importance of environmental and social responsibility in healthcare decision-making and encourages healthcare providers to consider the broader impact of medical treatments on the environment and society.
VI. Transparency and Accountability
The Declarant emphasizes the importance of transparency and accountability in healthcare decision-making processes, urging healthcare providers to communicate openly and honestly with patients and their families regarding treatment options, risks, and benefits.
VII. Revocation of Prior Directives
The Declarant hereby revokes any prior advance directives, living wills, or healthcare proxies previously executed by them and declares that this Declaration shall serve as the sole expression of their end-of-life care preferences.
VIII. Acknowledgment and Witness
The Declarant affirms that they have read and understood the contents of this Declaration and that the statements herein accurately reflect their wishes regarding end-of-life care. The Declarant further acknowledges that they are executing this Declaration voluntarily and without duress.
IX. Signature
In witness whereof, the Declarant has executed this Declaration on this [DATE] day of [MONTH], [YEAR], at [PLACE OF EXECUTION].
[PATIENT'S NAME]
Date: [DATE]
[WITNESS'S NAME]
Date: [DATE]
