New York Living Will Template
This Living Will is established in accordance with New York State laws, specifically under the state's guidelines regarding advance directives. This document allows individuals to outline their preferences for medical treatment in the event that they become unable to communicate their wishes.
Below are sections that must be filled out to ensure that your Living Will reflects your needs and preferences.
1. Personal Information
- Full Name: ____________________________
- Date of Birth: ____________________________
- Address: ____________________________
- Phone Number: ____________________________
2. Declaration
I, the undersigned, hereby declare that if I am unable to make my own medical decisions, I wish for the following preferences to be honored:
3. Medical Treatment Preferences
- Life-Sustaining Treatment: I wish to receive (choose one):
- ❏ All available treatments
- ❏ No life-sustaining treatment under any circumstances
- ❏ Only those treatments that are specific to my situation: ____________________________
- Pain Management: I wish to receive pain relief, even if it may hasten my death. ❏ Yes ❏ No
- Organ Donation: Upon my death, I wish to (choose one):
- ❏ Donate my organs
- ❏ Not donate my organs
4. Signatures
By signing below, I affirm that this Living Will reflects my healthcare wishes:
- Signature: ____________________________
- Date: ____________________________
This document must be recognized and witnessed according to New York law.
5. Witness Information
Two witnesses must sign below, certifying that the principal is of sound mind and not under duress:
- Witness Name 1: ____________________________ Signature: ____________________________
- Witness Name 2: ____________________________ Signature: ____________________________
6. Notarization (Optional)
While notarization is not required, you may choose to have this document notarized for additional validation:
- Notary Public Name: ____________________________
- Date: ____________________________
- Signature: ____________________________
This Living Will is a critical document that should be discussed with your family and healthcare providers to ensure that your wishes are clearly understood. Review and update this Living Will periodically as your circumstances and preferences may change.