Washington Living Will Template
This Living Will is created in accordance with Washington state laws regarding advance directives. It outlines your preferences for medical treatment in case you become unable to communicate your wishes.
Personal Information:
- Name: ____________________________
- Date of Birth: ______________________
- Address: ___________________________
- City, State, Zip Code: ______________
- Phone Number: ______________________
Declaration: I, _____________________________, being of sound mind, willfully and voluntarily make this declaration. If I become unable to make decisions regarding my medical treatment due to illness or incapacitation, I direct my healthcare providers to follow these instructions:
- If I am in a terminal condition, my life should not be prolonged by medical treatment. I do not wish to receive treatments that would artificially prolong the dying process.
- If I am in a state of permanent unconsciousness, I do not want any life-sustaining treatment.
- If I have a serious, irreversible condition that may not be terminal, I may want specific treatments withheld or discontinued if they cause pain or suffering.
- If I have any specific wishes regarding organ donation, please document those wishes here: ___________________________________________________.
Healthcare Agent: I designate the following person as my healthcare agent to make decisions on my behalf if I am unable to do so:
- Name: ____________________________
- Relationship: ______________________
- Phone Number: _____________________
Signature:
I understand the purpose and effect of this document. I am signing this Living Will voluntarily, and I am of sound mind.
Signature: _________________________
Date: ______________________________
Witness Signature:
Two witnesses are required. Neither witness should be a relative or entitled to any part of the estate.
Witness 1: _______________________________ (Signature)
Date: _____________________________
Witness 2: _______________________________ (Signature)
Date: _____________________________
This document should be kept in a safe place and shared with your healthcare agent and family members.