West Virginia Living Will FormWest Virginia Living Will Form
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The Kind of Medical Treatment I Want and Do Not Want If I have
a Terminal Condition or Am In a Persistent Vegetative State
Living will made this___________ day of___________________________________ ( month, year).
l,______________________________________________________________________ , being of
sound mind, willfully and voluntarily declare that I want my wishes to be respected if I
am very sick and not able to communicate my wishes for myself. In the absence of my
ability to give directions regarding the use of life-prolonging medical intervention, it is my
desire that my dying shall not be prolonged under the following circumstances:
I f I am very sick and not able to communicate my wishes for myself and I am certified
by one physician, who has personally examined me, to have a terminal condition or to
be in a persistent vegetative state (I am unconscious and am neither aware of my
environment nor able to interact with others,) I direct that life-p