Florida Living Will
This Living Will is created in accordance with Florida Statutes Chapter 765, which governs advance directives.
I, [Insert Your Full Name], of [Insert Your Address], being of sound mind, wish to make known my desires regarding medical treatment in the event that I become unable to communicate my wishes due to a terminal condition or an end-stage condition.
In the event that my attending physician and a second physician determine that I have a terminal condition or an end-stage condition, I direct the following:
- If I am unable to participate in my treatment decisions, I do not want life-prolonging procedures that would only serve to prolong the dying process.
- I wish to receive care that will provide me with comfort and relieve suffering, which may include medication and other treatments to manage pain.
- If I am diagnosed as being in a persistent vegetative state, I do not wish to receive life-prolonging treatment.
Additionally, I express my wishes regarding:
- Artificial nutrition and hydration: [State Your Wishes Here]
- Resuscitation: [State Your Wishes Here]
- Other specific medical wishes: [State Your Wishes Here]
I appoint the following individuals to be my health care surrogate, should I be unable to make decisions for myself:
- Name: [Insert First and Last Name], Phone: [Insert Phone Number]
- Name: [Insert First and Last Name], Phone: [Insert Phone Number]
In executing this Living Will, I affirm that I am of sound mind and that I understand the implications of this document. This declaration reflects my desires and preferences related to medical treatment and is made freely, without coercion.
Signed on this [Insert Day] of [Insert Month, Year].
Signature: [Your Signature]
Witnesses:
- Name: [Witness Name], Date: [Insert Date], Signature: [Witness Signature]
- Name: [Witness Name], Date: [Insert Date], Signature: [Witness Signature]