Louisiana Living Will Template
This Living Will is designed in accordance with Louisiana state laws regarding advance healthcare directives. It expresses your wishes concerning medical treatment under certain conditions.
Principal Information:
- Name: ___________________________
- Address: _________________________
- City: ____________________________
- State: ___________________________
- Zip Code: ________________________
Declaration of Wishes:
I, __________________________ (Name), being of sound mind, voluntarily make known my desire that my dying not be prolonged under certain conditions. If I become unable to make decisions regarding my medical treatment, I direct the following:
- If I have an incurable and irreversible condition that will result in death in a relatively short time, and I am unable to make decisions about my care, I do not wish to receive life-sustaining treatment.
- If I am in a persistent vegetative state, I do not want life-sustaining treatment that would only prolong my life artificially.
- I wish to receive pain relief and comfort care even if it may hasten my death.
If at any time I am unable to communicate my wishes regarding medical treatment, I authorize the following individual to make decisions on my behalf:
- Name of Agent: ______________________
- Relationship: ________________________
- Address: ____________________________
- Phone Number: ______________________
Signature:
By signing below, I confirm that I understand the contents of this Living Will and that I am doing so voluntarily.
Signature: ___________________________
Date: ________________________________
Witnesses:
This Living Will must be signed in the presence of two witnesses who are at least 18 years of age and not named as beneficiaries in this document.
- Witness 1 Name: ______________________
- Signature: ___________________________
- Date: ________________________________
- Witness 2 Name: ______________________
- Signature: ___________________________
- Date: ________________________________
It is recommended that you provide copies of this Living Will to your healthcare provider, family members, and anyone involved in your care.