Living Will Form

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The Connecticut Attorney General offers a free living will form that you can print and complete. While it isn't
pleasant to contemplate being unable to communicate your preferences to health care providers, a living will can
ensure that the decision as to whether to receive life support is yours. It can also spare your family much
heartache in making this very difficult decision.
Connecticut Attorney General's Office -- Attorney General Richard Blumenthal
Your Rights to Make Health Care Decisions
Questions and Answers
You have the right to make health care decisions about the medical care you receive. If you do not want
certain treatments, you have the right to tell your physician you do not want them.
You also have the right to receive information from your physician to assist you in reaching a decision about
what medical care is to be provided to you.
There may come a time when you are unable to actively participate in determining your treatment due to
serious illness, injury or other disability.
This file discusses the options available in Connecticut to help you to convey written instructions to guide
your physician, family and others as to what treatment choices you desire to be made if you can not express
your wishes.
Frequently Asked Questions
Do I have the right to make health care decisions? Yes. Adult patients in Connecticut have the right to
determine what, if any, medical treatment they will receive. As a capable adult, you may agree to treatment
that may help you or you may refuse treatment even if the treatment might keep you alive longer.
Do I have the right to information needed to make a health care decision? Yes. Physicians have the
responsibility to provide patients with information that can help them to make a decision. Your physician
will explain:
what treatments may help you;
how each treatment may effect you, that is, how it can help you and what, if any, serious problems or
side effects the treatment is likely to cause;
what may happen if you decide not to receive treatment.
Your physician may also recommend what, if any, treatment is appropriate, but the final decision is yours to
make. All of this information is provided so you can exercise your right to decide your treatment wisely.
What is an advance directive? An advance directive is a legal document through which you may provide
your directions or wishes as to your medical care. It is used when you are unable to make or communicate
your decisions about your medical treatment.
It is prepared before any condition or circumstance occurs that causes you to be unable to actively make a
decision about your medical care.
THIS IS A SAMPLE AND OFFERED SOLELY FOR THE ASSISTANCE OF ATTORNEYS WHO WILL BE RESPONSIBLE FOR THE
ULTIMATE SUBSTANCE AND WORDING OF THE DOCUMENT. THE USE OF THIS SAMPLE BY PARTIES OTHER THAN ATTORNEYS
IS NOT AUTHORIZED

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