Rights Of The Terminally Ill Act

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INSTRUCTIONS
To Living Will
A living will is a written document which directs your physician to
withhold or stop life-sustaining medical procedures if you develop a
terminal condition and can’t state your wishes at the time a decision about
those kinds of procedures must be made.
Rhode Island law suggests a form of living will but does not require
its exclusive use. If you decide to sign a living will, you may use the form
supplied with these instructions or make your own living will form. If you
use this form, please read and follow these instructions carefully.
1. Print your name in the first line of the form.
2. Place a check mark in the third paragraph to indicate whether you want artificially-
administered nutrition and hydration (food and water) to be stopped or withheld like
any other life-sustaining treatment. Remember, if you do not want artificial nutrition
and hydration, your living will must say so.
3. Complete the day, month and year that you sign at the bottom of this form.
4. Sign your name on the signature line (or if you are unable to do so, have someone do
it for you) before two (2) witnesses who know you and are at least 18 years old.
5. Print your address on the address line.
6. Have the two (2) witnesses sign their names and print their addresses where indicated
below your signature. The witnesses may not be related to you by blood or marriage.
7. Give a signed copy of your living will to your physician for your medical records.
Remember, you may revoke your living will at any time simply by telling your
physician not to follow it.
NOTE: This information is provided to make you generally aware of Rhode Island law
about living wills and is not intended as legal advice for your particular situation. For
legal advice about living wills or your health care rights, you should consult with an
attorney.

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