E
elisaortiz
Guest
What is the name of your state? NY
I want to check if my living will meets all the requirements (I wrote it myself with the help of some other legal websites) so I was hoping someone on here could just look it over?
I, ----, being of sound mind, make this statement as a directive to be followed if I become permanently unable to participate in decisions regarding my medical care. In this event, I appoint ----as my primary health care agent. In the event that the primary health care agent is unable, unwilling or unavailable to act as my health care agent, I hereby appoint ----as my secondary health care agent. If at any time it appears that my primary agent is unable or unwilling to abide by this directive, I give the nursing staff assigned to my case the authorization to revoke the authority of my primary agent and defer to my secondary agent.
I hereby direct my health care agent to make health care decisions in accordance with my wishes and instructions as stated explicitly in this document. Additionally, I direct my agent to abide by any limitations on his or her authority as stated explicitly in this document.
During the time I am incompetent, my agent, as named above, is authorized to consent, refuse or withdraw consent to any and all types of medical decisions on my behalf, consistent with the policy below, after consultation with my health care provider(s), utilizing the most current diagnosis and/or prognosis of my medical condition excepting the special situations described below.
My agent is granted access to medical records and information to the same extent that I am entitled, including the right to disclose the contents to others as appropriate for my health care; authorization for my admission or discharge (even against medical advice) from any hospital, nursing home, residential care, assisted living or similar facility or service; authorization to contract on my behalf for any health care related service or facility on my behalf, without my agent incurring personal financial liability for such contracts; authorization to hire and fire medical, social service, and other support personnel responsible for my care; authorization to take any other action necessary to do what I authorize here, including (but not limited to) granting any waiver or release from liability required by any hospital, physician, or other health care provider; authorization to sign any health care related documents; authorization to pursue any legal action in my name at the expense of my estate to force compliance with my wishes as determined by my agent acting upon the instructions laid forth in this document, or to seek actual or punitive damages for the failure to comply; any other legal or medical decisions or permission that may arise during the period of my incapacitation.
I direct that:
1. That all decisions and actions taken by my agent on my behalf will supercede any and all imposed decisions made by members of my family, regardless of my families intentions.
2. This directive is intended to be valid in any jurisdiction in which it is presented. A copy of this directive is intended to have the same effect as the original.
3. The instructions in this document are to be followed even if suicide is alleged to be attempted at some point after it is signed.
4. No fewer than two separate physicians and any other additional experts, as deemed necessary, make the determination that I am incapacitated.
5. That I be provided basic nursing care and procedures to provide comfort care.
6. That under any medical conditions, food, water and/or any form of healthy sustenance shall be provided to me orally or intravenously to the full extent necessary both to preserve my life and to assure me the optimal health possible.
7. That medication to alleviate any pain I experience, as well as any recommended antibiotics, be provided to me despite the severity of my condition.
8. That any organs (excluding my corneas) that can be harvested from my body shortly before or after my death, shall be donated for transplant, therapy, or research.
9. That under no circumstances is amputation to be performed.
Special Conditions:
1. If it has been determined that I have an incurable terminal illness or injury, and will die imminently- meaning that a reasonably prudent physician, knowledgeable about the case and the treatment possibilities with respect to the medical conditions involved, would judge that I will live only three months or less even if life saving treatment or care is provided to me, or if I have been judged by my health care providers to be brain dead, severely brain damaged with no chance of recovery, in an irreversible coma or a persistent vegetative state, - the following may be withheld or withdrawn as determined by the decision of my health care agent: Surgery of any type, medication (excluding the limitations above), resuscitative measures (including CPR), and any additional treatments.
2. If I am pregnant, I direct my health care provider(s) and health care agent to use all lifesaving procedures for myself with none of the conditions referenced in Special Condition Part 1 applying if there is a chance that prolonging my life in a manner that might allow my child to be born alive. I also direct that lifesaving procedures be used even if I am legally determined to be brain dead if there is a chance that doing so might allow my child to be born alive. No one, including my health care agent, is authorized to consent to any procedure that would result in the death of my unborn child, including direct procedures such as sterilization or abortion and indirect procedures such as ceasing life support. I direct my health care agent and all associated physicians and health care professionals to consider my unborn child's life more valuable than my own when determining a course of medical action.
By signing here I indicate that I understand the contents of this document and the effect of this grant of powers to my agent.
I sign my name to this Health Care Advanced Directive on this
____ day of __________________, 200_
___________________________________
---
I declare that ---is personally known to me, that she signed this health care advance directive in my presence, and that she appears to be of sound mind and under no duress, fraud, or undue influence.
___________________________________ ___________________________________
Witness #1 Witness #2
I, __, signing here I indicate that I understand the contents of this document and the effect of this grant of powers as a health care agent for ---.
I sign my name to this Health Care Advanced Directive on this
____ day of __________________, 200_
_____________________________
__
I declare that __is personally known to me, that she signed this health care advance directive in my presence, and that she appears to be of sound mind and under no duress, fraud, or undue influence.
___________________________________ ___________________________________
Witness #1 Witness #2
I, __, signing here I indicate that I understand the contents of this document and the effect of this grant of powers as a health care agent for ---.
I sign my name to this Health Care Advanced Directive on this
____ day of __________________, 200_
_____________________________
__
I declare that __is personally known to me, that he signed this health care advance directive in my presence, and that he appears to be of sound mind and under no duress, fraud, or undue influence.
___________________________________ ___________________________________
Witness #1 Witness #2
I want to check if my living will meets all the requirements (I wrote it myself with the help of some other legal websites) so I was hoping someone on here could just look it over?
I, ----, being of sound mind, make this statement as a directive to be followed if I become permanently unable to participate in decisions regarding my medical care. In this event, I appoint ----as my primary health care agent. In the event that the primary health care agent is unable, unwilling or unavailable to act as my health care agent, I hereby appoint ----as my secondary health care agent. If at any time it appears that my primary agent is unable or unwilling to abide by this directive, I give the nursing staff assigned to my case the authorization to revoke the authority of my primary agent and defer to my secondary agent.
I hereby direct my health care agent to make health care decisions in accordance with my wishes and instructions as stated explicitly in this document. Additionally, I direct my agent to abide by any limitations on his or her authority as stated explicitly in this document.
During the time I am incompetent, my agent, as named above, is authorized to consent, refuse or withdraw consent to any and all types of medical decisions on my behalf, consistent with the policy below, after consultation with my health care provider(s), utilizing the most current diagnosis and/or prognosis of my medical condition excepting the special situations described below.
My agent is granted access to medical records and information to the same extent that I am entitled, including the right to disclose the contents to others as appropriate for my health care; authorization for my admission or discharge (even against medical advice) from any hospital, nursing home, residential care, assisted living or similar facility or service; authorization to contract on my behalf for any health care related service or facility on my behalf, without my agent incurring personal financial liability for such contracts; authorization to hire and fire medical, social service, and other support personnel responsible for my care; authorization to take any other action necessary to do what I authorize here, including (but not limited to) granting any waiver or release from liability required by any hospital, physician, or other health care provider; authorization to sign any health care related documents; authorization to pursue any legal action in my name at the expense of my estate to force compliance with my wishes as determined by my agent acting upon the instructions laid forth in this document, or to seek actual or punitive damages for the failure to comply; any other legal or medical decisions or permission that may arise during the period of my incapacitation.
I direct that:
1. That all decisions and actions taken by my agent on my behalf will supercede any and all imposed decisions made by members of my family, regardless of my families intentions.
2. This directive is intended to be valid in any jurisdiction in which it is presented. A copy of this directive is intended to have the same effect as the original.
3. The instructions in this document are to be followed even if suicide is alleged to be attempted at some point after it is signed.
4. No fewer than two separate physicians and any other additional experts, as deemed necessary, make the determination that I am incapacitated.
5. That I be provided basic nursing care and procedures to provide comfort care.
6. That under any medical conditions, food, water and/or any form of healthy sustenance shall be provided to me orally or intravenously to the full extent necessary both to preserve my life and to assure me the optimal health possible.
7. That medication to alleviate any pain I experience, as well as any recommended antibiotics, be provided to me despite the severity of my condition.
8. That any organs (excluding my corneas) that can be harvested from my body shortly before or after my death, shall be donated for transplant, therapy, or research.
9. That under no circumstances is amputation to be performed.
Special Conditions:
1. If it has been determined that I have an incurable terminal illness or injury, and will die imminently- meaning that a reasonably prudent physician, knowledgeable about the case and the treatment possibilities with respect to the medical conditions involved, would judge that I will live only three months or less even if life saving treatment or care is provided to me, or if I have been judged by my health care providers to be brain dead, severely brain damaged with no chance of recovery, in an irreversible coma or a persistent vegetative state, - the following may be withheld or withdrawn as determined by the decision of my health care agent: Surgery of any type, medication (excluding the limitations above), resuscitative measures (including CPR), and any additional treatments.
2. If I am pregnant, I direct my health care provider(s) and health care agent to use all lifesaving procedures for myself with none of the conditions referenced in Special Condition Part 1 applying if there is a chance that prolonging my life in a manner that might allow my child to be born alive. I also direct that lifesaving procedures be used even if I am legally determined to be brain dead if there is a chance that doing so might allow my child to be born alive. No one, including my health care agent, is authorized to consent to any procedure that would result in the death of my unborn child, including direct procedures such as sterilization or abortion and indirect procedures such as ceasing life support. I direct my health care agent and all associated physicians and health care professionals to consider my unborn child's life more valuable than my own when determining a course of medical action.
By signing here I indicate that I understand the contents of this document and the effect of this grant of powers to my agent.
I sign my name to this Health Care Advanced Directive on this
____ day of __________________, 200_
___________________________________
---
I declare that ---is personally known to me, that she signed this health care advance directive in my presence, and that she appears to be of sound mind and under no duress, fraud, or undue influence.
___________________________________ ___________________________________
Witness #1 Witness #2
I, __, signing here I indicate that I understand the contents of this document and the effect of this grant of powers as a health care agent for ---.
I sign my name to this Health Care Advanced Directive on this
____ day of __________________, 200_
_____________________________
__
I declare that __is personally known to me, that she signed this health care advance directive in my presence, and that she appears to be of sound mind and under no duress, fraud, or undue influence.
___________________________________ ___________________________________
Witness #1 Witness #2
I, __, signing here I indicate that I understand the contents of this document and the effect of this grant of powers as a health care agent for ---.
I sign my name to this Health Care Advanced Directive on this
____ day of __________________, 200_
_____________________________
__
I declare that __is personally known to me, that he signed this health care advance directive in my presence, and that he appears to be of sound mind and under no duress, fraud, or undue influence.
___________________________________ ___________________________________
Witness #1 Witness #2