Washington Living Will
This Living Will is made pursuant to the laws of the State of Washington. It expresses my wishes regarding medical treatment and life-sustaining measures in the event that I become unable to communicate my wishes.
Personal Information:
- Name: ________________________________________________
- Date of Birth: ________________________________________
- Address: ______________________________________________
- City, State, Zip Code: ________________________________
- Phone Number: ________________________________________
Health Care Wishes:
In the event that I am diagnosed with a terminal condition or am permanently unconscious, I hereby state my wishes regarding health care:
- If I am unable to speak for myself, I do not wish for life-sustaining treatment to be administered if it serves only to prolong the dying process.
- I would like to receive palliative care to alleviate suffering while respecting my wishes regarding life-sustaining measures.
- If my condition is reversible and I have a reasonable chance of recovery, I wish to receive all appropriate medical treatment.
Designation of Health Care Agent:
I designate the following person as my health care agent to make decisions on my behalf:
- Name of Agent: __________________________________________
- Address: ___________________________________________
- Phone Number: _______________________________________
Optional Instructions:
Feel free to include any specific instructions regarding medical treatment or organ donation:
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_____________________________________________________________
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Signature: _______________________________________________
Date: _________________________________________________