South Carolina Living Will Declaration FormSouth Carolina Living Will Declaration FormSouth Carolina Living Will Declaration Form
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DECLARATION OF A DESIRE FOR A NATURAL DEATH
STATE OF SOUTH CAROLINA
I,

COUNTY OF
(

/
/
), Declarant, being at least eighteen
Social Security Number
years of age and a resident of and domiciled in the City of
, County of
, State of South Carolina, make this Declaration this
day of
, 20______.
I willfully and voluntarily make known my desire that no life-sustaining procedures be used to prolong my
dying if my condition is terminal or if I am in a state of permanent unconsciousness, and I declare:
If at any time I have a condition certified to be a terminal condition by two physicians who have personally
examined me, one of whom is my attending physician, and the physicians have determined that my death could
occur within a reasonably short period of time without the use of life-sustaining procedures or if the physicians
certify that I am in a state of permanent unconsciousness and where the application of life-sustaining procedures
would serve only to prolong the dying process, I direc