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Fillable Form Living Will Declaration

Living Will Declaration is a legal document that outlines the preference with regards to what life-saving measures medical staff and first-responders are allowed to perform. It also states what end-of-life pain management and comfort measures to be administered during the closing phase of a life.

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What is a Living Will Declaration?

A Living Will Declaration, also known as Living Will or Health Care Declaration, is a document used to give instructions for your care if you have a terminal condition. It is also used to describe the type of health care you want to receive in the event you become incapacitated.

A Living Will Declaration Form is usually paired with a power of attorney for your health care, where you need to name an agent to decide on your behalf. It also directs withdrawal or withholding of medical procedures that artificially prolong the dying process. It also requests to die naturally with the use of appropriate medication to ease the pain.

The declarant shall also have the choice if they want to have artificially-supplied nutrition and hydration by stating it in a Living Will Declaration Form. Only competent adults, meaning those who are of sound mind and legal age, shall have the right to control decisions regarding their medical care, such as life-prolonging procedures.

In executing a Living Will, the declarant must take note of the following:

  • It must be in writing;
  • It must be voluntarily made;
  • It must be signed by the declarant or another person in their presence at their express direction;
  • It must be dated; and
  • It must be signed in the presence of at least two competent witnesses who are of legal age or at least 18 years old.

The declarant may also revoke a living will at any time. The requirements for revoking a living will are as follows:

  • The document must be written, signed, and written;
  • There must be physical cancellation or destruction of the document by you or another person in your presence and at your direction; and
  • There must be an oral expression of your intention to revoke the living will.

You may download a PDF copy of a Living Will Declaration Form anywhere online, but you may electronically fill it out on PDFRun for your convenience.

How to fill out a Living Will Declaration?

Living Will of:

Enter the name of the declarant.

Name

Enter the name of the declarant.

City

Enter the city the declarant resides.

County

Enter the county the declarant resides.

State

Enter the state the declarant resides.

The first paragraph of the Living Will Declaration states that this instrument is directed to the declarant’s family, physician(s), attorney, clergyman, any medical facility in whose care they happen to be, and any individual who may become responsible for their health, welfare, or affairs.

The second paragraph explains that death is a reality as birth, growth, maturity, and old age, and it is certain. This statement shall stand as the declarant’s expression of their wishes while they are still of sound mind, for the time when they may no longer take part in decisions for their future.

The third paragraph states that if the declarant has a terminal condition and their attending physician has determined that they cannot recover from the said condition and their death is imminent, where the application of the life-prolonging procedures and “heroic measures” would serve only to prolong the dying process, they direct that such procedures be withheld or withdrawn and be permitted to die naturally.

It also states further that the declarant does not fear death and the indignities of deterioration, dependence, and hopeless pain. The declarant asks that their medication shall be mercifully administered to them and the medical procedures are deemed necessary to alleviate the pain and bring them comfort and care.

The fourth paragraph states that in the absence of the declarant to give directions about the use of such life-prolonging procedures, this declaration shall be honored by the declarant’s family and physician as the final expression of their legal right to refuse medical or surgical treatment and accept the consequences for such refusal.

The fifth paragraph states that if the declarant is diagnosed as comatose, incompetent, or mentally or physically incapable of communication, the declarant shall appoint someone to make binding decisions concerning their medical treatment.

Appointee

Enter the full legal name of the appointee.

The sixth paragraph states that if the declarant is pregnant and the diagnosis is known by their physician, the declaration shall have no force or effect during their pregnancy.

The seventh and last paragraph states that the declarant understands the full import of the Living Will Declaration and they are emotionally and mentally competent to make this declaration. It is in the hope of the declarant that whoever is appointed will feel morally bound to follow its mandate.

It also states further that the declarant recognizes that while this declaration appears to place a heavy responsibility on the appointee, it is intending to relieve the latter of such responsibility and of placing it upon the declarant, by their strong convictions, that this statement is made.

The "In Withness Whereof" clause states that the declarant subscribes their name and affixed their seal at the indicated located on the said date and in the presence of the subscribing witnesses to whom they have requested to become attesting witnesses.

Location

Enter the location the declarant affixed their seal.

Date

Enter the date.

Declarant

Affix the signature of the declarant.

Witness #1 Signature

Have Witness Number 1 affix their signature.

Witness #1 Printed Name

Enter the full legal name of Witness Number 1.

Witness #2 Signature

Have Witness Number 2 affix their signature.

Witness #2 Printed Name

Enter the full legal name of Witness Number 2.

How to file a Living Will Declaration?

Once you made a Living Will Declaration PDF, have it printed and give a copy to your family members, physician, health care agent, and your hospital or healthcare facility. A living will declaration is helpful once you become incapacitated because it will state your wishes for you. However, this document shall only be effective if those who are taking care of you know about your condition.

Before you give copies of your living will declaration, it is a must to notarize it before a notary public. A certificate of acknowledgment from a notary public verifies and confirms that the declarant willingly signed the document in his presence.

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