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Living Will Template
I, [NAME], a resident of [CITY], [STATE], in [COUNTRY], with an
address at [ADDRESS], being of sound mind, memory, disposition,
understanding, and at least eighteen years of age, do willfully and
freely, by this Living Will, direct my family, physician(s), attorney,
and any other individuals who may in the future become
responsible for my health and well-being and any decisions
related thereto, whether partly or fully, to take the following
actions in each of the circumstances described in this Living Will
In the event that I develop a condition deemed to be
“terminal” and my attending physician and one other physician
have both determined/agreed that there is no chance for recovery
from this terminal condition, I request/direct the following:
a. Indicate either “Do not prolong my life using artificial life
support” or “Use whatever life-prolonging procedures are
available to prolong my life.”
b. Indicate either “Do not administer food or water artificial