Fillable Living Will Form (Page 5 of 10) in pdf

After I complete an advance directive, can I revoke it? Yes. You can revoke your living will or

appointment of a health care agent at any time, either orally or in writing and remember to tell your physician

and others who have copies of your advance directive. To revoke your designation of a conservator, you can

do so either in writing, by destroying the document or by making a new designation which states that earlier

designations are revoked. It is advisable to put any revocation in writing.

If I already have a living will, do I need a new one? No. Connecticut's living will statutes were revised

effective October 1, 1993. If your living will and other advance directives were completed prior to this date,

they are valid, but probably looks different than the one in this booklet. On October 1, 1993, a new combined

form was created which is contained in this booklet. However, all other forms remain valid and still can be

used.

If I don't have an advance directive, how will my wishes be considered if I am unable to speak for

myself? If you are unable to make and communicate your decision concerning your medical care and you

do not have a living will, your physician can consult with other persons to determine what your wishes are

regarding the withholding or withdrawal of life support systems. If you have discussed your wishes with

your physician, he or she will, of course, know your stated wishes. Your physician may also ask your health

care agent, your next of kin or close relatives and your conservator, if one has been appointed, what you have

told them about your wishes regarding withholding or withdrawing life support systems.

It is not recommended that you rely on oral instructions to these individuals to make your wishes known. If

there is no living will, such instructions are required to be specific and may need to be proven in a court. You

are better advised to complete a living will if you want to be sure that your wishes will be understood and

known in the event you are unable to state them yourself.

What is a document of anatomical gift? It is document in which you make a gift of all or any part of your

body to take effect upon death. Any adult may make an anatomical gift in writing, including through a will, a

donor card or by a statement imprinted or attached to a motor vehicle operator's license. An anatomical gift

may be made for the purpose of transplants, therapy, research, medical or dental education, or the

advancement of medical or dental science. If you do not limit the gift's purpose to one or some of these uses,

the gift can be used for any of these purposes. You may select who receives the gift - a hospital, physician,

college, or an organ procurement group. You may also specify that the gift be used for transplant or therapy

for a particular person. If no one is named to receive the gift, any hospital may do so.

Can I revoke an anatomical gift? Yes. An anatomical gift may be revoked or changed only by (1) a signed

statement; (2) an oral statement in the presence of two witnesses; (3) or by informing your physician if you

are in a terminal condition. An anatomical gift may not be revoked after the donor's death.

What if I have more questions? If you have additional questions about advance directives, discuss them

with your physician and family. A social worker, patient representative or chaplain may be able to assist you,

but they cannot provide legal advice. If you have legal questions, you should speak with a lawyer.

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

Living Will Form Page 5