Living Will Form Page 2
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In Connecticut, there are three types of advance directives:
•
the living will or health care instructions
•
the appointment of a health care agent
•
the appointment of an attorney-in-fact for health care decisions, also called a durable power of
attorney for health care decisions.
Must I have an advance directive? No. You do not have to make a living will or other type of advance
directive to receive medical care or to be admitted to a hospital, nursing home or other health care facility.
No person can be denied medical care or admission based on whether or not they have signed a living will or
other type of advance directive.
If someone refuses to provide you medical care or admit you unless you sign a living will or other type of
advance directive, contact the Department of Public Health and Addiction Services in Hartford, Connecticut.
What is a living will? A living will is a document that states whether you wish to have administered life
sustaining procedures or treatment should you be in a terminal condition or permanently unconscious. The
living will tells your physician whether you want "life support systems" to keep you alive in these situations
or whether you do not want to receive such treatment, even if the result is your death. A living will goes into
effect only (1) when you are unable to make or communicate your decisions about your medical care and (2)
when you are in a terminal condition or permanently unconscious.
A patient is in a "terminal condition" when the physician finds that the patient has a condition which is (1)
incurable or irreversible and (2) will result in death within a relatively short time if life support systems are
not provided. "Permanently unconscious" means a permanent coma or persistent vegetative state where the
patient is not aware of himself or his surroundings and is unresponsive.
What is a life support system? A "life support system" is a form of treatment that only delays the time of
your death or maintains you in a state of permanent unconsciousness. Life support systems may include
among other things:
•
devices such as respirators and dialysis;
•
cardiopulmonary resuscitation (CPR);
•
food and fluids supplied by artificial means, such as feeding tubes and intravenous fluids.
It does not include
•
normal feeding and fluids, such as by hand or straw;
•
medications such as antibiotics in special circumstances.
Will I receive medication for pain if I have a living will? Yes. A living will does not affect the provision
of pain medication or care designed solely to maintain your physical comfort (for example, care designed to
maintain your circulation or health of your skin and muscles). This type of care will be provided whenever
appropriate.
What is a health care agent? A health care agent is a person whom you authorize in writing to convey your
wishes concerning whether you wish to withhold or withdraw life support systems. The agent does not
become involved in any other treatment decisions. A health care agent does not act unless you are unable to
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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