Hawaii Living Will Template
This Living Will is made in accordance with the laws of the State of Hawaii. It outlines my wishes regarding medical treatment in the event that I am unable to communicate my preferences.
Personal Information
- Name: ________________________________
- Date of Birth: ________________________
- Address: ______________________________
- City: _________________________________
- State: Hawaii
- Zip Code: ____________________________
Declaration
I, ________________________________, being of sound mind, voluntarily make this declaration as a Living Will. This document reflects my wishes regarding medical treatment if I am unable to make my own decisions.
Medical Treatment Preferences
If I become terminally ill or permanently unconscious, I wish to make the following choices regarding my medical treatment:
- If I am unable to communicate, I do not wish to receive life-sustaining treatment that only prolongs the dying process.
- I wish to receive comfort care, including pain relief, even if it may hasten my death.
- If I am diagnosed with a terminal illness, I do not wish to be resuscitated.
Appointment of Healthcare Agent
I hereby appoint the following individual as my healthcare agent:
- Name: ________________________________
- Address: ______________________________
- Phone Number: ________________________
Signatures
This Living Will is made on this _____ day of ____________, 20____.
Signature: ________________________________
Witness 1: _______________________________
Witness 2: _______________________________
Notarization (if required)
State of Hawaii
County of _______________________________
Subscribed and sworn before me on this _____ day of ____________, 20____.
Notary Public: ___________________________
My Commission Expires: __________________