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LIVING WILL
I, _____________________________________, a resident of the State of ___________________, being of sound mind, do hereby willfully and voluntarily make known my desire that my life not be prolonged under any of the following conditions, and do hereby further declare:
If I should, at any time, have an incurable condition caused by any disease or illness, or by any accident or injury, and be determined by any two or more physicians to be in a terminal condition whereby the use of "heroic measures" or the application of life-sustaining procedures would only serve to delay the moment of my death, and where my attending physician has determined that my death is imminent whether or not such "heroic measures" or life-sustaining measures are employed, I direct that such measures and procedures be withheld or withdrawn and that I be permitted to die naturally.
In the event of my inability to give directions regarding the application of life-sustaining procedures or the use of "heroic measures", it is my intention that my family and my physicians shall honor this directive as my final expression of my right to refuse medical and surgical treatment, and my acceptance of the consequences of such refusal.
I declare that I am mentally, emotionally and legally competent to make this directive and I fully understand its import.
I reserve the right to revoke this directive at any time. This directive shall remain in force until revoked.
_____________________________________________________ ____________________ Signature Date
COUNTY OF )
STATE OF )
Subscribed and sworn before me this the _____ day of ____________, 20__.
Warning:
These forms are provided AS IS. They may not be any good. Even if they are good in one jurisdiction, they may not work in another. And the facts of your situation may make these forms inappropriate for you. They are for informational purposes only, and you should consult an attorney before using them.
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