Florida Living Will
This document is a Florida made by [YOUR NAME], hereinafter referred to as the "Principal", residing at [YOUR COMPANY NAME]. It is my intention through this Advance Directive to state my wishes regarding the medical treatment I wish to receive in situations where I am unable to communicate my desires due to illness or incapacity.
I. Declaration
I, [YOUR NAME], being of sound mind and not under duress, fraud, or undue influence, do hereby declare this document as my Living Wil. I expressly authorize and designate [DESIGNATED HEALTHCARE PROXY'S NAME] as my health care agent (hereinafter referred to as "Healthcare Proxy") to make health care decisions on my behalf as specified in this Directive.
II. Medical Power of Attorney
The individual that I have decided upon and am proceeding to designate as my Healthcare Proxy is as follows:
Name: | [DESIGNATED HEALTHCARE PROXY'S NAME] |
Relationship: | [RELATIONSHIP TO PRINCIPAL] |
Address: | [PROXY'S ADDRESS] |
Phone Number: | [PROXY'S PHONE NUMBER] |
III. Preferences for Life-Sustaining Treatment
If I am unable to make my own healthcare decisions, I direct my healthcare team and my Healthcare Proxy to follow these instructions:
Use of mechanical ventilation: Do Not Administer
Use of tube feeding: Do Not Administer
Use of cardiopulmonary resuscitation (CPR): Do Not Administer
Other life-sustaining measures:
No Dialysis: I do not wish to undergo dialysis if my kidneys fail and it is not reversible.
No Invasive Procedures: Avoid invasive procedures that do not directly contribute to comfort or quality of life.
Comfort-focused Care: I prioritize comfort and palliative care to alleviate suffering and maintain dignity.
IV. Durable Power of Attorney for Health Care Decisions
This directive grants full power to my Healthcare Proxy to make all healthcare decisions for me, including the right to refuse or consent to treatment, to the extent allowed by law, when I cannot do so for myself. The authority of my Healthcare Proxy under this durable power of attorney shall be effective immediately and shall not require a determination of my incapacity.
V. Revocation and Duration
This Living Will is to remain in effect until such time that I opt to revoke it. Any alterations or modifications to this document will not hold any value or become effective unless it has been formally put down in writing and has been signed by me, or it has been signed under my explicit instruction.
VI. Signatures and Witnesses
This Advance Directive will not be effective unless it is signed, dated, and witnessed by at least two individuals who meet the requirements for witnesses in the state of Florida.
[YOUR NAME]
[DATE SIGNED]
Witness 1:
[WITNESS 1'S NAME]
[DATE SIGNED]
Witness 2:
[WITNESS 2'S NAME]
[DATE SIGNED]
VII. Additional Information
In addition to my preferences for life-sustaining treatment, I would like to specify the following instructions and conditions for my healthcare:
Palliative Care Consultation: I request a palliative care consultation as soon as it is determined that my condition is serious and life-limiting, to ensure that my symptoms are effectively managed and my comfort is prioritized.
Family Involvement: I want my family and loved ones to be actively involved in discussions about my care and treatment decisions. Please ensure they are informed and supported throughout the process.
Advanced Directives: Please honor any advanced directives or living wills that I have put in place, and communicate these clearly with my healthcare team and my Healthcare Proxy.
Quality of Life Considerations: I prioritize interventions that will enhance my quality of life and comfort over those that may merely prolong life without meaningful improvement in health or well-being.
Regular Communication: I request regular updates on my condition and treatment plan, conveyed to both me (if possible) and my designated Healthcare Proxy.
Spiritual Support: If desired, please arrange for spiritual or religious support that aligns with my beliefs and brings me comfort during this time.
End-of-Life Wishes: Please respect my wishes for a peaceful and dignified end-of-life experience, ensuring that my values and preferences are honored to the fullest extent possible.
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