Ohio Living Will
This document serves as a Living Will, expressing your wishes regarding medical treatment in the event that you become unable to communicate those wishes yourself. It is drafted in accordance with Ohio state laws and ensures that your healthcare preferences are honored.
Personal Information
- Name: _______________________________
- Date of Birth: _______________________
- Address: _____________________________
- City: ________________________________
- State: _______________________________
- ZIP Code: ____________________________
Declaration
I, _______________________________ (full name), being of sound mind, declare this to be my Living Will, executed on this ______ day of __________, 20___.
Medical Treatment Preferences
If I am diagnosed with a terminal condition or am in a state of irreversible coma, I do not want my life to be prolonged by medical treatment if the treatment will only prolong the process of dying. My wishes are as follows:
- I choose to withhold life-sustaining treatment, including but not limited to:
- Mechanical ventilation
- Cardiac resuscitation
- Dialysis
- Nutrition and hydration by artificial means
- In the case of a terminal illness, I wish to receive palliative care and comfort measures.
- I nominate the following individual as my healthcare proxy:
Healthcare Proxy Information
- Name: _______________________________
- Relationship: _________________________
- Address: ____________________________
- Phone Number: ______________________
Witnesses
This Living Will must be witnessed by at least two individuals who are not related to me by blood, marriage, or adoption and who are not entitled to any portion of my estate.
- Witness 1 Name: ______________________
- Witness 1 Signature: _________________
- Witness 2 Name: ______________________
- Witness 2 Signature: _________________
This Living Will is designed to reflect my desires and must be honored as such. I revoke any prior Living Wills or declarations regarding my medical treatment.