Clinical Will
I. Introduction
This Clinical Will is made on [Date] by [Your Name], residing at [Your Address], to specify my wishes and directives regarding medical treatment and healthcare decisions if I am unable to communicate my wishes due to incapacity.
II. Appointment of Healthcare Agent
2.1 Healthcare Agent: I appoint [Name of Healthcare Agent] (hereinafter referred to as "Agent"), residing at [Agent's Address], as my healthcare agent to make healthcare decisions on my behalf.
2.2 Powers and Authority: My Agent shall have full authority to make decisions regarding my medical treatment, including but not limited to surgical procedures, medications, and life-sustaining measures.
III. Statement of Wishes
3.1 General Medical Care: It is my wish that my healthcare providers administer all necessary medical treatments to relieve pain and suffering.
3.2 Life-Sustaining Treatment: In the event of irreversible coma or terminal illness with no chance of recovery, I [choose/do not choose] to receive life-sustaining treatment, including artificial nutrition and hydration.
3.3 Organ and Tissue Donation: I hereby authorize the donation of my organs and tissues for medical purposes upon my death, subject to medical suitability.
IV. Specific Instructions
4.1 End-of-Life Care: I request that all medical care provided be focused on ensuring comfort and dignity at the end of life.
4.2 Funeral and Burial Instructions: My preferred arrangements for funeral services include a simple ceremony followed by a burial in the family plot at [Cemetery Location].
V. Legal Provisions
5.1 Revocation: I reserve the right to revoke or amend this Clinical Will at any time, provided I am of sound mind and able to communicate my intentions.
5.2 Governing Law: This Clinical Will shall be governed by the laws of [Your State/Country].
VI. Signatures
In witness thereof, I have signed my name on this [Date].
[Your Name]
VII. Witnesses
Witness 1
Name: [Witness 1 Name]
Address: [Winess 1 Address]
[Date Signed]
Witness 2
Name: [Witness 2 Name]
Address: [Winess 2 Address]
[Date Signed]
VIII. Notary
On this [Date], before me, [Notary's Name], a notary public in and for the said state, personally appeared [Your Name], known to me to be the person described in and who executed the foregoing instrument, and acknowledged that he/she executed the same as his/her free act and deed.
Notary Public: [Notary's Name]
My Commission Expires: [Expiration Date]
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