Examples for business, study, careers, love, and more...
Examples :: Business Examples :: Example of Living Will

Example of Living Will

To all my family, doctors, surgeons, hospital, medical providers, and all other medical care persons:

I, [Name], being of sound mind and logical thought, willfully and voluntarily make this declaration to be followed should I become incapacitated or unable to express my own decisions regarding my own medical treatment.

This declaration represents my informed, firm and settled commitment to refuse any life-sustaining treatment under the circumstances listed below.

This declaration and the following instructions are a statement of my legal right to refuse life-sustaining medical treatment or care. I trust the parties mentioned to consider themselves as morally and legally bound to act in accordance to my wishes and preferences. The mentioned parties should then be free of any liabilities legal or otherwise for having followed this declaration and the directions that it contains.

Directions

  1. I instruct my attending doctors or primary care givers to withhold or withdraw any life-sustaining medical care or treatment that is only serving to prolong the process of my death should I be in an incurable or irreversible physical or mental condition with no medical expectation of recovery.
  2. I instruct that treatment be limited to methods which are designed to keep me in comfort and free of pain, including any pain which might result from withholding or withdrawing any life sustaining medical treatment.
  3. I instruct that if I am in any of the conditions described in item 1, that it be remembered that I specifically DO NOT want the following types of medical care or treatment:
    1. ___________________________
    2. ___________________________
    3. ___________________________
    4. ___________________________
    5. ___________________________
    6. ___________________________
    7. ___________________________
    8. ___________________________
  4. I instruct that if I am in any of the conditions described in item1, that it be remembered that I specifically DO want the following types of medical care or treatment:
    1. ___________________________
    2. ___________________________
    3. ___________________________
    4. ___________________________
    5. ___________________________
    6. ___________________________
    7. ___________________________
    8. ___________________________
  5. I instruct that if I am in the condition described in item 1, and if I have the affliction or afflictions of the following disease, illness or injury, that I receive the following medical treatment and care:

    This Living Will Declaration is made the __________day of __________, 20__________.

    ______________________________________________________ Signature

    Witness Statements

    I declare that the persons who have signed this document are personally known to me, that the undersigned have acknowledged this Living Will Declaration in my presence, and that the undersigned are of sound mind and are under no duress, fraud or other influence.

    ___________________________________ Date___________________ Witness Signature

    ___________________________________ Date___________________ Witness Signature

PLEASE READ THE TERMS OF USE ON PAGE 4 BEFORE USING THIS DOCUMENT.

Terms of Use

ExamplesOf.com Terms of Use applies to the information and files that are downloaded from Examplesof.com. You can also view specific end-user license agreements in the templates and/or spreadsheets downloaded from ExamplesOf.com.

End User License Agreement

Limited Use Policy

These templates provided by ExamplesOf.com, may be downloaded and customized for your personal or company use only. You may download copies, make archival copies and customize the template to be distributed and used within your company. This template or any document produced from this template may NOT be sold, redistributed, or uploaded to the internet for distribution.

Business card examples may be used for your own use cannot be published in digital format on private or public networks with out written permission from Examplesof.com

Do not remove, replace or alter any logo, copyright information, trademark, disclaimer or Terms of Use from this template.

Limited Warranty

ExamplesOf.com offers a limited warranty provided after the delivery of any documents. This limited warranty includes:
- The documents provided will be defect free in quality and workmanship under normal use circumstances, and
- Each document will perform according to its instruction and documentation.

Under the extent permitted by law, THIS LIMITED WARRANTY COVERS ALL OTHER WARRANTIES OR CONDITIONS, EXPRESSED OR IMPLIED. EXAMPLESOF.COM ALSO DISCLAIMS ANY IMPLIED WARRANTIES regardless of prior knowledge to any persons particular use of the product. No representative of ExamplesOf.com is authorized to modify or promise additional warranties. This limited warranty provides the consumer with certain and specific legal rights.

Limitation of Liability

EXAMPLESOF.COM IN NO EVENT WILL BE LIABLE FOR LOSS OF PROFITS, DAMAGES, SAVINGS LOST, OR OTHER DIRECT OR INDIRECT LOSS OR DAMAGES AS A RESULT FROM USING OUR TEMPLATES OR SPREADSHEETS OR THE INABILITY TO CORRECTLY USE OUR PRODUCTS (EVEN UNDER ADVISEMENT OF THE POSSIBILITY OF DAMAGES). WE ALSO DENY ANY LIABILITY OR RESPONSIBILITY FOR ANY MISTAKES OR NEGLIGENCE WHEN DEVELOPING THIS TEMPLATE OR SPREADSHEET. THE PERSON USING THIS TEMPLATE OR SPREADSHEET BEARS ALL RESPONSIBILITY AND RISKS FOR THE ACCURATE USE AND QUALITY OF PRODUCT PRODUCED FROM USING THESE DOCUMENTS.

The above liability limitation may not apply if the state you live in does not allow the exclusion or limitation of liability or damages.