Texas Living Will
This Living Wil is made by [YOUR NAME], herein referred to as the "Principal," currently residing at [YOUR COMPANY ADDRESS]. This document outlines my wishes concerning medical treatment choices in situations where I am no longer capable of making decisions due to incapacitation. This directive is executed as per the laws of the State of Texas.
I. Declaration
I, [YOUR NAME], being of sound mind and not acting under duress, fraud, or undue influence, do hereby declare this to be my directive regarding my health care and medical treatment options. This directive shall only become effective should I become unable to communicate my wishes directly.
II. Appointment of Health Care Agent
In the event I become unable to make my own healthcare decisions, I appoint the following individual as my Health Care Agent:
Name: | [AGENT'S NAME] |
Relationship: | [AGENT'S RELATIONSHIP] |
Address: | [AGENT'S ADDRESS] |
Phone Number: | [AGENT'S PHONE NUMBER] |
Email: | [AGENT'S EMAIL] |
My Health Care Agent shall have full authority to make decisions about my health care according to the wishes I have expressed in this directive.
III. Living Will Declaration: Medical Treatment Preferences
Should I become incapacitated, I direct that my healthcare providers and my agent follow my wishes as detailed below:
If I am in a terminal and irreversible condition:
Preference regarding life-sustaining treatment: Withhold
(I do not wish to receive life-sustaining treatment such as CPR, mechanical ventilation, or other invasive measures if I am in a terminal and irreversible condition.)
Specific instructions about artificial nutrition and hydration: Withhold
(I do not wish to receive artificial nutrition or hydration (tube feeding) if I am in a terminal and irreversible condition.)
If I am in a permanently unconscious state:
Preference regarding life-sustaining treatment: Withhold
(I do not wish to receive life-sustaining treatment such as CPR, mechanical ventilation, or other invasive measures if I am in a permanent unconscious state.)
Specific instructions about artificial nutrition and hydration: Withhold
(I do not wish to receive artificial nutrition or hydration (tube feeding) if I am in a permanent unconscious state.)
Additional instructions (if any):
Please ensure that my comfort and dignity are prioritized in any medical decisions made on my behalf.
I designate [HEALTHCARE PROXY'S NAME], located at [HEALTCARE PROXY'S ADDRESS], as my agent to make healthcare decisions on my behalf if I cannot.
Important Notes:
Ensure that your living will comply with the legal requirements of your state or jurisdiction.
Discuss your preferences with your healthcare provider and your designated healthcare proxy.
Keep copies of your living will with your medical records, and provide copies to your healthcare proxy, family members, and relevant healthcare providers.
IV. Signature
This document is signed on [DATE] at [YOUR COMPANY ADDRESS].
[YOUR NAME]
V. Witnesses
The Principal has signed this document in our presence, and according to the Principal, they are at least eighteen years of age, of sound mind, and under no constraint or undue influence.
Witness 1:
[WITNESS 1'S NAME]
[DATE SIGNED]
Witness 2:
[WITNESS 2'S NAME]
[DATE SIGNED]
VI. Notary (if applicable)
State of Texas
On this [DATE], before me, [NOTARY PUBLIC'S NAME], a notary public, personally appeared [YOUR NAME], known to me (or satisfactorily proven) to be the person whose name is subscribed to this directive, and they acknowledged that they executed the same for the purposes therein contained.
Notary Public: [NOTARY PUBLIC'S NAME]
Commission Expires: [EXPIRATION DATE]
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