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The Living Will E-mail

Print the living will below or download it as a word document.  Once you have filled in all your details and dated it, this document will serve as your own Living Will.  Witnesses should NOT be members of the family, beneficiaries, trustees or the executor of the last will and testament.  The living will is not part of the last will and testament.

 

For more information about the Living Will, see 'Living Will Info'.

 


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E-mail
The Living Will 
 
 TO MY FAMILY AND PHYSICIAN:

 

This declaration is made by me (full name) ...................................................

I.D. Number: ..........................................................................................................

Address: ................................................................................................................

.................................................................................................................................

 

If the time comes when I can no longer take part in decisions for my own future, let this declaration stand as the testament to my wishes.

 

If there is no reasonable prospect of my recovery from physical illness or impairment in which I am suffering continual pain or am incapable of ever again living a rational existence and when I am no longer capable of being consulted regarding my wishes, I request that I be allowed to die with dignity and not be kept alive by artificial means. I request that they administer whatever drugs necessary to keep me comfortable during this period even if it may reduce the length of my life.

 

This form is signed and dated by me in the presence of the two undersigned witnesses who at my request in my presence have given their names as witnesses.

 

Signed: .........................................  
   
Date: ............................................  
   
   
Witnessed by:  
   
Signed: ......................................... Signed: .........................................
   
Name: .......................................... Name: ...........................................

 

 


 

Quotes

‎"Walk tall as the trees; live strong as the mountains; be gentle as the spring winds, keep the warmth of summer in your heart, and the Great Spirit will always be with you." 

anonymous, native American 

  


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