Appendix E
SAMPLE LIVING WILL

A living will simply states your wishes for end-of-life care. It is not legally binding, but usually it is honored. It can be an extremely useful instrument in conjunction with a medical proxy statement (which is a legal assignment of decision-making power to an agent that becomes operative when and if you are no longer able to speak for yourself). The living will can be appended to your medical proxy statement as an optional addendum. It may say anything you wish regarding your preferences, and the following is a sample only. Alter it in any way you wish. It does not require an attorney—only a witness, preferably two.

Living Will Declaration

To my family, doctors, and all those concerned with my care:

I, , being of sound mind, make this statement as a directive to be followed if for any reason I become unable to participate in decisions regarding my medical care.

I direct that life-sustaining procedures should be withheld or withdrawn if I have an illness, disease, or injury, or experience extreme mental deterioration, such that there is no reasonable expectation of recovering or regaining a meaningful quality of life. Life-sustaining procedures that may be withheld or withdrawn include, but are not limited to: surgery, antibiotics, cardiopulmonary resuscitation, respiratory support, and artificially administered feeding and fluids.

I further direct that treatment be limited to comfort measures only. I wish medication for pain and other distress to be used liberally in doses sufficient to relieve my symptoms, even if such medication were to shorten my life.

Other Personal Instructions

These directions express my legal right to refuse treatment. Therefore, I expect my family, doctors, and all those concerned with my care to regard themselves as morally bound to act in accord with my wishes, and, in so doing, to be free from any liability for having followed my directions.