Living Will

The time to make decisions about your wishes in event of serious illness/injury is now.  As long as you are able to indicate your preferences, each aspect o the living will is subject to change at your request. 

The living will is a guide for your family and medical care providers at the time when end of this life seems near and you are no longer able to indicate your wishes.

There is no best set of choices.  Your choices are the ones we wish to honor.  it is good to discuss this with your family and medical care providers. 

For a living will you can type your own information and decisions into and print out, please click here.

Following is a sample living will:
 

HOSPITAL CARE AND END OF LIFE WISHES

I,__________________________, WISH SUPPORTIVE CARE AND TREATMENT OF

DANGEROUS HEART RHYTHMS, 

FURTHER, I ___ DO, ___ DO NOT WANT CPR (CARDIOPULMONARY RESUSCITATION SHOULD MY HEART STOP, OR I AM FOUND UNRESPONSIVE AND NOT BREATHING.

IF I AM UNABLE TO SWALLOW BECAUSE OF DISEASE OR STROKE:

I____ DO,____, DO NOT WANT GASTRIC OR JEJUNOSTOMY FEEDING TUBE

I____ DO,____, DO NOT WANT A TEMPORARY NASOGASTRIC FEEDING TUBE

I____ DO,____, DO NOT WANT TO BE FED THROUGH MY VEINS (TPN)

I____ DO,____, DO NOT WANT I.V. THERAPIES (HYDRATION, ANTIBIOTICS)

IF I AM VERY ANEMIC, I____ DO,____, DO NOT WANT A BLOOD TRANSUFION

____________________________________    _________________
Signature                                                                     Date

_______________________________    __________________
Social security number                                  Birth date

____________________________________   _________________
Witness Signature                                                     Date