I, ______________, being of sound mind, willfully and voluntarily make known my desire that my life shall not be artificially prolonged under the circumstances set forth in this directive.
If at any time I should have an incurable or irreversible condition caused by injury, disease, or illness certified to be a terminal condition by two physicians, and if the application of life-sustaining procedures would serve only to artificially postpone the moment of my death, and if my attending physician determines that my death is imminent or will result within a relatively short time without the application of life-sustaining procedures. I direct that those procedures be withheld or withdrawn, and that I be permitted to die naturally.
In the absence of my ability to give directions regarding the use of those life-sustaining procedures, it is my intention that this directive be honored by my family and physicians as the final expression of my legal right to refuse medical or surgical treatment and accept the consequences form that refusal.
If I have been diagnosed as pregnant and that diagnosis is known to my physician, this directive has no effect during my pregnancy.
This directive is in effect until it is revoked.
I understand the full import of this directive and I am emotionally and mentally competent to make this directive.
I understand that I may revoke this directive as any time.
I request that only comfort care be provided to me, no antibiotics, no artificial nutrition, no mechanical ventilation, and no hydration. It is my strong preference to be allowed to die outside of a care facility if possible, even if that preference is determined by my physician to shorten my period of dying. The only condition under which I desire these preferences for end of life care to be altered is in the case of possible organ and tissue donation. I request that any and all organs and tissue that may be salvaged be provided for transplant. My remains may then be cremated and buried _____________________.
Signed Date
Print Name
Witness Date
Witness Name and Address
You will find a Living Will here for your use, free of charge. There is no registration required to use this form. Please print and share it with all those within your circle of influence. We also provide links to other sites offering free Living Wills for your use. This is an exceedingly important decision, amplified even more by Terri Schiavo's plight with end-of-life issues. Please carefully consider what you would want, and complete the forms accordingly. We suggest you give signed copies to your family, to your doctor, to your attorney, and keep a copy with your will.
Links to other sites offering Living Wills:
Living Wills Registry in U.S.: http://www.uslivingwillregistry.com/
Living Wills Registry in Canada: http://www.sentex.net/~lwr/about.html
