New York Living Will printable pdf download

NEW YORK LIVING WILL

This declaration is intended to serve as a guide to assist my duly appointed

health care agent in making medical decisions on my behalf. However, it is not

intended to limit my health care agent’s sole discretion to interpret this

document and to make medical decisions in good faith after full consideration

of my medical condition and prognosis. If my health care agent is unable to

serve for any reason, my attending physicians shall comply with my directions.

I, _____________________________, being of sound mind, make this statement as a

directive to be followed if I become permanently unable to participate in decisions

regarding my medical care. These instructions reflect my firm and settled commitment

to decline medical treatment under the circumstances indicated below:

I direct my attending physician to withhold or withdraw treatment that merely prolongs

my dying, if I should be in an incurable or irreversible mental or physical condition

with no reasonable expectation of recovery.

These instructions apply if I am a) in a terminal condition; b) permanently

unconscious; or c) minimally conscious but have irreversible brain damage and will

never regain the ability to make decisions and express my wishes.

I direct that treatment be limited to measures to keep me comfortable and to relieve

pain, including any pain that might occur by withholding or withdrawing treatment.

While I understand that I am not legally required to be specific about future treatments,

if I am in the condition(s) described above, I feel especially strongly about the

following forms of treatment:

I do not want cardiac resuscitation.

I do not want mechanical respiration.

I do not want tube feeding.

I do not want antibiotics.

I do want maximum pain relief.

Other directions: _____________________________________________________

___________________________________________________________________

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New York Living Will