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Pennsylvania Living Will Template
This Living Will is made in accordance with the laws of the Commonwealth of Pennsylvania. It is designed to communicate your wishes regarding medical treatment in the event that you become unable to express them yourself.
I, [Your Full Name], born on [Your Date of Birth], residing at [Your Address], hereby declare this to be my Living Will.
If at any time I am diagnosed with a terminal illness, injury, or condition and cannot make my own medical decisions, I express my wishes regarding the use of life-sustaining treatment as follows:
- I do not want life-sustaining treatments to be initiated or continued if they would only prolong the process of dying.
- I do want the following treatments to be administered if I am in a terminal condition:
- Cardiopulmonary resuscitation (CPR)
- Artificial nutrition and hydration
- Mechanical ventilation
Additionally, I wish to appoint the following individual as my Health Care Agent:
[Agent's Full Name], residing at [Agent's Address], phone number [Agent's Phone Number].
In the event that the individual above is unable or unwilling to serve, I further appoint:
[Alternate Agent's Full Name], residing at [Alternate Agent's Address], phone number [Alternate Agent's Phone Number].
My Health Care Agent shall have the authority to make healthcare decisions on my behalf in accordance with my wishes as expressed in this Living Will. If my wishes are not clear, I trust my agent to act in what they believe are my best interests.
In witness whereof, I have signed this Living Will on [Date].
Signature: ____________________________
Witness 1: _______________________________
Witness 2: _______________________________
This document must be signed in the presence of two adult witnesses who are not related to you by blood or marriage, and are not entitled to your estate.
Form Data
| Fact Name | Details |
|---|---|
| Purpose | A Pennsylvania Living Will outlines a person's wishes regarding medical treatment in case they become unable to communicate their preferences. |
| Governing Law | The Pennsylvania Living Will is governed by the Pennsylvania Consolidated Statutes, Title 20, Chapter 54. |
| Eligibility | Any adult who is of sound mind can create a Living Will in Pennsylvania. |
| Witness Requirement | The Living Will must be signed by the individual and witnessed by two adults who are not related to the individual or beneficiaries. |
| Revocation | A person can revoke their Living Will at any time, verbally or in writing, as long as they are still competent. |
| Healthcare Proxy | While a Living Will states treatment preferences, it does not appoint a healthcare proxy. A separate document is needed for that. |
| Storage | It is advisable to keep the Living Will in a safe place and share copies with family members and healthcare providers. |
Pennsylvania Living Will - Usage Guidelines
Completing the Pennsylvania Living Will form is an important step in ensuring your healthcare preferences are known and respected. Follow these steps to accurately fill out the form.
- Obtain the Pennsylvania Living Will form. You can find it online or request a physical copy from a healthcare provider.
- Read the instructions carefully. Familiarize yourself with the sections of the form to understand what information is required.
- Begin by filling in your personal information. Include your full name, address, and date of birth at the top of the form.
- Clearly state your wishes regarding medical treatment. Use the designated sections to indicate your preferences for life-sustaining treatments.
- If you have specific instructions or preferences, write them in the provided space. Be as clear and concise as possible.
- Designate a healthcare agent if desired. This person will make decisions on your behalf if you are unable to do so.
- Sign and date the form. Ensure your signature is legible, as this validates your wishes.
- Have the form witnessed. Pennsylvania requires two witnesses to sign the form, confirming that you signed it voluntarily.
- Make copies of the completed form. Keep one for your records and provide copies to your healthcare agent and primary physician.
Some Other Living Will State Templates
Will Legal - Health care professionals often consult a Living Will for guidance on patient preferences and values.
Completing the Colorado Homeschool Letter of Intent is vital for parents to inform their local school district about their choice to educate their children at home. This essential document not only fulfills the legal requirements but also sets the foundation for a successful homeschooling journey. For detailed guidance and to access the necessary forms, you can visit Colorado PDF Templates.
California Living Will - Some people may choose to include “Do Not Resuscitate” (DNR) orders in their Living Will as part of their end-of-life preferences.
Dos and Don'ts
When filling out the Pennsylvania Living Will form, it’s important to be careful and thorough. Here are some dos and don’ts to keep in mind:
- Do: Clearly state your wishes regarding medical treatment.
- Do: Sign and date the form in the presence of two witnesses.
- Do: Keep a copy for yourself and provide copies to your healthcare providers.
- Do: Review and update your Living Will as your wishes change.
- Don't: Leave any sections blank; ensure everything is filled out completely.
- Don't: Use witnesses who are related to you or who will benefit from your estate.
- Don't: Forget to discuss your wishes with your loved ones.
- Don't: Assume your verbal wishes will be honored without documentation.
Common mistakes
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Not Clearly Stating Preferences: Many individuals fail to clearly articulate their medical preferences. It's essential to specify what types of medical treatment you would or would not want in various scenarios.
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Inadequate Witness Signatures: The form requires two witnesses. Some people forget to have both witnesses sign, or they choose witnesses who are not eligible, such as family members or those who might inherit from the individual.
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Neglecting to Date the Document: A common oversight is not dating the Living Will. Without a date, it can be challenging to determine the most current wishes of the individual.
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Using Ambiguous Language: Vague terms can lead to confusion. It’s important to use specific language when describing your wishes regarding life-sustaining treatments.
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Failing to Discuss Wishes with Family: Not talking to family members about your Living Will can create misunderstandings. Open conversations help ensure that your loved ones understand your wishes.
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Not Reviewing the Document Regularly: Life circumstances change. Failing to review and update your Living Will can lead to it not reflecting your current preferences.
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Ignoring State-Specific Requirements: Each state has its own rules regarding Living Wills. Some individuals overlook the specific requirements for Pennsylvania, which can lead to invalid documents.
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Assuming Oral Wishes are Sufficient: Some people believe that simply expressing their wishes verbally is enough. However, without a written document, those wishes may not be honored in a medical crisis.