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Small
Business Home >> Useful
Standard Legal Documents >>
Living Will (Male)
I, __________(1)_____________, of ___________(2)____________,
being of sound mind, do hereby willfully and voluntarily make
known my desire that my life not be prolonged under any of
the following conditions, and do hereby further declare:
1. If I should, at any time, have an incurable condition
caused by any disease or illness, or by any accident or injury,
and be determined by any two or more physicians to be in a
terminal condition whereby the use of "heroic measures"
or the application of life-sustaining procedures would only
serve to delay the moment of my death, and where my attending
physician has determined that my death is imminent whether
or not such "heroic measures" or life-sustaining
measures are employed, I direct that such measures and procedures
be withheld or withdrawn and that I be permitted to die naturally.
2. In the event of my inability to give directions regarding
the application of life-sustaining procedures or the use of
"heroic measures", it is my intention that this
directive shall be honored by my family and physicians as
my final expression of my right to refuse medical and surgical
treatment, and my acceptance of the consequences of such refusal.
3. I am mentally, emotionally and legally competent to make
this directive and I fully understand its import.
4. I reserve the right to revoke this directive at any time.
5. This directive shall remain in force until revoked.
IN WITNESS WHEREOF, I have hereto set my hand and seal this
_(3)_ day of _______(4)_______, 19_(5)_.
______________(6)______________ Declaration of Witnesses
The declarant is personally known to me and I believe him
to be of sound mind and emotionally and legally competent
to make the herein contined Directive to Physicians. I am
not related to the declarant by blood or marriage, nor would
I be entitled to any portion of the declarant's estate upon
his decease, nor am I an attending physician of the declarant,
nor an employee of the attending physician, nor an employee
of a health care facility in which the declarant is a patient,
nor a patient in a health care facility in which the declarant
is a patient, nor am I a person who has any claim against
any portion of the estate of the declarant upon his death.
____________(7)_________________ _____________(8)_______________
____________(9)_________________ _____________(10)______________
___________(11)_________________ _____________(12)______________
NOTICE
The information in this document is designed to provide an
outline that you can follow when formulating business or personal
plans. Due to the variances of many local, city, county and
state laws, we recommend that you seek professional legal
counseling before entering into any contract or agreement.
If this document is of use
to you, please provide a link back to Hoover Web Design.
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