Valid  Living Will Template for New York

Valid Living Will Template for New York

A New York Living Will form is a legal document that allows individuals to express their preferences regarding medical treatment in the event they become unable to communicate their wishes. This form ensures that healthcare providers and loved ones understand the individual's desires concerning life-sustaining measures. By completing a Living Will, individuals can take control of their healthcare decisions and provide peace of mind for themselves and their families.

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In the fast-paced world we live in, planning for the future often takes a backseat to everyday responsibilities. However, having a New York Living Will can provide peace of mind by ensuring that your healthcare wishes are respected when you are unable to communicate them yourself. This important document outlines your preferences regarding medical treatment and end-of-life care, guiding healthcare providers and loved ones in making critical decisions on your behalf. It addresses various scenarios, such as whether you wish to receive life-sustaining treatments or palliative care in the event of a terminal illness or irreversible condition. By clearly articulating your desires, the Living Will not only alleviates the burden on family members during difficult times but also helps to prevent potential conflicts among loved ones. Understanding how to properly fill out and execute this form is essential, as it must meet specific legal requirements to be valid in New York. With the right knowledge, you can take a proactive step in safeguarding your healthcare choices and ensuring that your voice is heard, even when you cannot speak for yourself.

New York Living Will Sample

New York Living Will

This Living Will is made in accordance with New York State law and outlines your wishes regarding medical treatment and end-of-life decisions.

Personal Information:

  • Name: ___________________________
  • Date of Birth: _____________________
  • Address: ___________________________
  • City, State, Zip: _____________________
  • Phone Number: _______________________

Declaration:

I, ___________________, being of sound mind, willfully and voluntarily make this declaration to specify my wishes regarding medical care in the event that I am unable to communicate such wishes myself.

Health Care Decisions:

If I am diagnosed with a terminal illness, or if I am in a persistent vegetative state or an end-stage condition, I wish to make the following decisions:

  1. Life-Sustaining Treatment: I wish to receive the following life-sustaining treatments: __________________________.
  2. Do Not Resuscitate (DNR) Order: I do ( ) do not ( ) want a DNR order.
  3. Nutrition and Hydration: I wish to receive ( ) or not receive ( ) artificial nutrition and hydration.

Designated Health Care Agent:

I appoint the following individual as my health care agent to make decisions on my behalf if I am unable to do so:

  • Name of Agent: ______________________
  • Relationship: ________________________
  • Phone Number: _______________________

Signature:

By signing below, I affirm that I am at least 18 years old and that this declaration reflects my wishes regarding medical treatment.

Signature: ___________________________

Date: _______________________________

Witnesses:

This document must be witnessed by at least two individuals who are not related to me and who do not stand to gain from my death.

  • Witness 1: _________________________ Signature: ________________________
  • Witness 2: _________________________ Signature: ________________________

It is important to review and update this Living Will as necessary to ensure that it reflects your current wishes.

Key takeaways

When filling out and using the New York Living Will form, keep these key points in mind:

  • Understand the purpose: A Living Will outlines your wishes regarding medical treatment in case you become unable to communicate.
  • Be clear and specific: Clearly state your preferences for life-sustaining treatments, such as resuscitation, feeding tubes, and ventilators.
  • Consult with loved ones: Discuss your wishes with family and friends to ensure they understand your preferences and can advocate for you.
  • Choose a healthcare proxy: Consider appointing someone you trust to make medical decisions on your behalf if you are unable to do so.
  • Sign and date the document: Ensure that you properly sign and date your Living Will, as this confirms its validity.
  • Store it safely: Keep the original document in a secure location, and provide copies to your healthcare proxy and medical providers.
  • Review regularly: Revisit your Living Will periodically to ensure it still reflects your current wishes and make updates as necessary.