Free District of Columbia Living Will

District of Columbia Living Will

This document serves as a District of Columbia Living Will for [YOUR NAME], henceforth referred to as "the Principal," prepared on [DATE], declaring the desires and preferences concerning medical treatment and end-of-life care. This document ensures that my wishes are respected and adhered to in situations where I am unable to communicate due to illness or incapacity.

I. Declaration

I, [YOUR NAME], residing at [YOUR COMPANY ADDRESS], being of sound mind and not being influenced by duress, pressure, or undue influence, do hereby declare this to be my living will, made according to my values and wishes.

II. Appointment of Health Care Proxy

I designate the following individual as my healthcare proxy to make medical decisions on my behalf should I become incapable of making my own decisions:

Name:	[HEALTHCARE PROXY'S NAME]
Relationship:	[RELATIONSHIP TO YOU]
Address:	[HEALTHCARE PROXY'S ADDRESS]
Phone Number:	[HEALTHCARE PROXY'S PHONE NUMBER]

If my primary proxy is unable, unwilling, or unavailable to act in this role, I designate the following individual as my alternate Health Care Proxy:

Name:	[ALTERNATE HEALTHCARE PROXY'S NAME]
Relationship:	[RELATIONSHIP TO YOU]
Address:	[ALTERNATE HEALTHCARE PROXY'S ADDRESS]
Phone Number:	[ALTERNATE HEALTHCARE PROXY'S PHONE NUMBER]

III. Health Care Instructions

My Health Care Proxy is authorized to make all health care decisions for me, including decisions about withholding or withdrawing treatment, by what I have stated below. My Health Care Proxy should seek to preserve my life as long as possible within the limits of generally accepted healthcare standards.

A. General Goals and Values

The things that I hold in high regard and appreciate greatly are:

Quality of Life: I prioritize maintaining a good quality of life, focusing on physical comfort, emotional well-being, and meaningful interactions with loved ones.
Autonomy and Dignity: It is important to me to maintain autonomy and dignity in all aspects of my care and decision-making process.
Pain Management: I wish to receive effective pain management and symptom relief to ensure my comfort and overall well-being.
Honest Communication: I value open and honest communication with my healthcare providers and family members about my condition, treatment options, and prognosis.
Family and Relationships: Maintaining connections with my family and loved ones is crucial to my well-being.
Respect for Personal Beliefs: I want my personal beliefs, values, and cultural practices to be respected and considered in my care.
Minimization of Burden: I prefer treatments and interventions that minimize physical and emotional burden on myself and my family, without compromising the effectiveness of care.

B. Specific Wishes

I possess particular emotions and sentiments concerning the following modes of therapeutic interventions or treatments:

Cardiopulmonary Resuscitation (CPR):	Withhold
	I do not wish to receive cardiopulmonary resuscitation (CPR) in the event of cardiac arrest.
Mechanical Ventilation:	Administer if beneficial short-term, but withhold if long-term or unlikely to improve quality of life
	I am open to receiving mechanical ventilation if it is likely to be beneficial in the short term and improve my chances of recovery.
Antibiotics:	Administer if beneficial for recovery, withhold if no meaningful improvement is expected
	I prefer to receive antibiotics if they are likely to be effective in treating a reversible infection that significantly impacts my health.
Tubal Feeding:	Withhold
	I do not wish to receive artificial nutrition or hydration (tubal feeding) if I am unable to eat or drink independently and if my condition is irreversible.
Other Treatment Preferences:	Pain Management: I prioritize effective pain management to ensure my comfort.
	Quality of Life Focus: I prefer treatments that focus on maintaining or improving my quality of life.
	Communication and Family Involvement: I value clear communication with my healthcare team and wish to involve my family in important medical decisions.

IV. Declaration Concerning Life-Sustaining Treatment

I direct that my health care providers and my Health Care Proxy follow these instructions when making decisions concerning the use of life-sustaining treatments:

In the case that I am diagnosed with a terminal condition, where the application of life-sustaining procedures would serve only to artificially prolong the process of dying, I request to be allowed to die naturally and to receive any necessary treatment to alleviate pain or discomfort.

V. Organ and Tissue Donation

I [CHOOSE "DO" OR "DO NOT"] wish to donate any needed organs or tissues upon my death. Specific donations I wish to make are as follows:

A. Organs:

Heart
Lungs
Liver
Kidneys

B. Tissues:

Corneas
Skin
Bone

C. Donation for Scientific Research:

VI. Execution

This living will shall be in effect until I revoke it. No alteration of this document will be effective unless it is executed with the same formality as this original directive.

I affirm that I am of sound mind that I am fully able to make this document and that it reflects my desires regarding my health care and the conditions under which I am willing to continue or discontinue medical treatment.

IN WITNESS WHEREOF, I have hereunto set my hand and seal on this day, [DATE].

[YOUR NAME]

VII. Witnesses

This document was signed in our presence by [YOUR FULL NAME] on [DATE]. The declarant, in our opinion, is of sound mind and was not under duress, fraud, or undue influence.

Witness 1:

[WITNESS 1'S NAME]

[DATE SIGNED]

Witness 2:

[WITNESS 2'S NAME]

[DATE SIGNED]

Will Templates @ Template.net

Achieve peace of mind with the District of Columbia Living Will Template from Template.net. This editable and customizable document enables you to legally express healthcare wishes. Personalize the form effortlessly using our Ai Editor Tool, simplifying your preparation for future medical decisions. Trust this resource to safeguard your directives effectively, ensuring clarity and control over healthcare preferences.