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Preview - Pennsylvania Living Will Form

Pennsylvania Living Will Template

This Living Will is created in accordance with the laws of Pennsylvania. It outlines your wishes regarding medical treatment in the event that you become unable to communicate your decisions.

Patient Information:

  • Name: ____________________________
  • Date of Birth: _____________________
  • Address: __________________________

Designation of Health Care Agent:

  • Name: ____________________________
  • Address: __________________________
  • Phone Number: ______________________

Statement of Wishes:

If I am diagnosed with a terminal condition or if I am permanently unconscious, I wish to make my medical preferences clear. In such circumstances, I request:

  1. To receive or not receive life-sustaining treatment as specified below:
    • Resuscitation: Yes / No
    • Mechanical ventilation: Yes / No
    • Artificial nutrition and hydration: Yes / No
  2. For my healthcare agent to make decisions on my behalf based on my stated preferences.

Signatures:

By signing below, I affirm that this Living Will reflects my wishes regarding medical treatment.

Patient Signature: _______________________ Date: _____________

Witness 1 Signature: ____________________ Date: _____________

Witness 2 Signature: ____________________ Date: _____________

Note: This document should be completed in accordance with Pennsylvania state laws. It is advisable to consult with a legal professional when preparing or finalizing your Living Will.

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Similar forms

A Living Will is an important document that outlines an individual's preferences regarding medical treatment in situations where they may no longer be able to communicate their wishes. It shares similarities with several other legal documents related to healthcare and personal decision-making. Here are nine documents that are similar to a Living Will:

  • Advance Healthcare Directive: This document combines a Living Will and a Durable Power of Attorney for Healthcare. It allows individuals to specify their medical treatment preferences and appoint someone to make decisions on their behalf.
  • California Small Estate Affidavit: For those managing small estates, the simple process of filing a Small Estate Affidavit can significantly expedite asset transfer without probate delays.
  • Durable Power of Attorney for Healthcare: This allows a person to appoint a trusted individual to make healthcare decisions for them if they become incapacitated, similar to the decision-making aspect of a Living Will.
  • Do Not Resuscitate (DNR) Order: A DNR order specifies that a person does not want to receive CPR or other life-saving measures in the event of cardiac arrest. It aligns with the wishes expressed in a Living Will regarding end-of-life care.
  • Physician Orders for Life-Sustaining Treatment (POLST): This is a medical order that outlines a patient's preferences for life-sustaining treatments. It is similar to a Living Will but is intended for patients with serious illnesses.
  • Healthcare Proxy: This document designates an individual to make healthcare decisions on behalf of another person, much like the decision-making authority granted in a Living Will.
  • Medical Power of Attorney: Similar to a Durable Power of Attorney for Healthcare, this document gives someone the authority to make medical decisions for another person if they are unable to do so themselves.
  • End-of-Life Care Plan: This is a more comprehensive document that outlines an individual's wishes regarding end-of-life care, including preferences for pain management, hospice care, and other treatments, akin to a Living Will.
  • Organ Donation Consent: While not directly related to medical treatment decisions, this document expresses an individual's wishes regarding organ donation, which can be part of broader end-of-life considerations.
  • Patient Advocate Designation: This document allows individuals to appoint a patient advocate who can help ensure that their healthcare preferences, similar to those in a Living Will, are honored by medical providers.

Understanding these documents can empower individuals to make informed decisions about their healthcare and ensure their preferences are respected in critical situations.