Living Will Document
Living Will Document
Prepared by: [YOUR NAME]
Email: [YOUR EMAIL]
Introduction
This Living Will is prepared to outline my wishes regarding medical treatment and end-of-life decisions should I become incapacitated and unable to communicate my preferences. The intent of this document is to ensure that my healthcare providers and family members are aware of my wishes and can act accordingly to respect them. This document is to be followed when I am unable to express my desires due to a medical condition or injury.
Living Will
I, [YOUR NAME], of 123 Maple Street, Springfield, IL, 62701, being of sound mind, make this Living Will to provide guidance for my medical care in the event I become incapacitated. This document reflects my wishes regarding end-of-life decisions and is intended to be followed by my healthcare providers, family, and any other individuals involved in my care.
1. Life-Sustaining Treatments
I do not wish to receive the following life-sustaining treatments if I am in a terminal condition or in a persistent vegetative state:
-
Ventilation (mechanical breathing assistance)
-
Feeding Tubes (artificial nutrition and hydration)
-
Dialysis (kidney function support)
-
Cardiopulmonary Resuscitation (CPR) (if my heart stops)
-
Other Treatments (as specified below)
2. Pain Management
I request that pain management measures be administered to provide comfort, even if they may hasten the end of my life.
3. Organ Donation
I wish to donate my organs and tissues for transplantation or medical research if I am eligible and if it does not conflict with my other wishes stated in this Living Will.
4. Designated Decision Maker
If I am unable to make decisions on my behalf, I designate the following individuals to make medical decisions according to this Living Will:
|
Name |
Relationship |
Address |
Phone Number |
Email Address |
|---|---|---|---|---|
|
Emily Johnson |
Sister |
456 Oak Lane, Springfield, IL, 62702 |
(555) 123-4567 |
|
|
Michael Brown |
Spouse |
789 Pine Road, Springfield, IL, 62703 |
(555) 234-5678 |
|
|
Sarah Davis |
Friend |
101 Birch Drive, Springfield, IL, 62704 |
(555) 345-6789 |
5. Revocation
This Living Will can be revoked or modified at any time by me, as long as I am of sound mind. Any changes or revocations will be communicated in writing.
6. Signatures
By signing below, I affirm that this Living Will represents my wishes regarding end-of-life decisions.
Signed:
[YOUR NAME]
Date: August 22, 2050
Witnesses:
-
Laura Green
Date: August 22, 2050 -
Robert White
Date: August 22, 2050
Prepared by:
[YOUR COMPANY NAME]
Company Number: [YOUR COMPANY NUMBER]
Address: [YOUR COMPANY ADDRESS]
Website: [YOUR COMPANY WEBSITE]
Social Media: [YOUR COMPANY SOCIAL MEDIA]
