New York Living Will Template
This Living Will is created in accordance with New York State laws regarding healthcare decisions. It outlines your wishes regarding medical treatment in the event you become unable to communicate those wishes yourself.
Personal Information:
- Name: ______________________________
- Date of Birth: ______________________
- Address: ____________________________
- City, State, Zip: ____________________
- Phone Number: _______________________
Declaration:
I, the undersigned, being of sound mind, do hereby declare this document to be my Living Will. I wish to make my healthcare preferences known in the event that I am unable to make decisions for myself.
Healthcare Preferences:
- If I am diagnosed with a terminal condition, I do not wish to receive life-sustaining treatment that would only prolong the dying process.
- If I am in a persistent vegetative state or diagnosed with an irreversible condition, I do not wish to receive life-sustaining treatment.
- I wish to receive pain relief and comfort care, even if it may hasten my death.
Appointment of Healthcare Proxy:
I hereby appoint the following individual as my healthcare proxy to make medical decisions on my behalf if I am unable to do so:
- Name: ______________________________
- Relationship: ________________________
- Phone Number: _______________________
Signatures:
By signing below, I confirm that I understand the contents of this Living Will and that it reflects my wishes regarding medical treatment.
Signature: ___________________________
Date: ________________________________
Witness Signature: _____________________
Date: ________________________________
Witness Signature: _____________________
Date: ________________________________