Living Will / Advance Healthcare Directive

Document your healthcare wishes for end-of-life situations

$29.00State-compliant template

What is a Living Will?

A Living Will (also called an Advance Healthcare Directive) documents your wishes for medical treatment if you become unable to communicate. It typically covers situations like terminal illness, permanent unconsciousness, or advanced dementia. This is different from a Healthcare Power of Attorney, which appoints someone to make decisions for you.

Your Information (Principal)

Full Legal Name *

Date of Birth

Street Address *

City *

State *

ZIP Code *

Governing State *

Healthcare Agent (Optional)

You may appoint someone to make healthcare decisions on your behalf if you cannot communicate.

Agent Name

Relationship

Agent Phone

Agent Address

Alternate Agent (if primary cannot serve)

General Healthcare Directive

Select your overall approach to end-of-life care when facing a terminal condition or permanent unconsciousness.

Use All Available Medical Treatment

I want all available medical treatment to prolong my life as long as possible, regardless of my condition or chances of recovery.

Comfort Care Only

If I have a terminal condition or am permanently unconscious, I want comfort care only. Do not use life-prolonging treatments; focus on keeping me comfortable and free from pain.

Limited Treatment

I want treatment attempted for a trial period. If there is no significant improvement, switch to comfort care only. See specific preferences below.

Let My Healthcare Agent Decide

I trust my healthcare agent to make these decisions based on the circumstances and what they believe I would want.

Specific Treatment Preferences

Indicate your preferences for specific medical treatments in end-of-life situations.

Treatment	I Want	I Refuse	Decide Later / Agent
CPR (Cardiopulmonary Resuscitation) Chest compressions and electric shock to restart the heart
Mechanical Ventilation Machine breathing assistance through a tube
Tube Feeding / IV Nutrition Artificial nutrition and hydration
Dialysis Machine filtering of blood when kidneys fail
Antibiotics for Life-Threatening Infections Treatment of severe infections
Blood Transfusions Receiving blood products
Major Surgery Invasive surgical procedures
Comfort Care / Pain Management Palliative care focused on comfort

Organ & Tissue Donation

I wish to donate any needed organs and tissuesI wish to donate only specific organs/tissues (specify below)I do not wish to donate any organs or tissuesI leave this decision to my healthcare agent / family

Additional Instructions

Religious or Personal Considerations

Pain Management Preferences

Other Instructions

Primary Physician (Optional)

Physician Name

Physician Phone

Document Summary

Principal:Not specified

State:Not specified

General Directive:comfort care

Healthcare Agent:None appointed

Organ Donation:undecided

Important Reminders:

• This document must be signed, dated, and witnessed according to your state's requirements
• Give copies to your healthcare agent, doctor, and family members
• Review and update this document periodically or after major life changes
• Consider discussing your wishes with your doctor and loved ones
• Some states require notarization - check your state's requirements