Article Guide
In the fast-paced world we live in, making decisions about our health care can often feel overwhelming, especially when faced with serious medical conditions. The New York Living Will form serves as a vital tool for individuals wishing to articulate their preferences regarding medical treatment in the event they become unable to communicate those wishes. This legal document empowers individuals to specify their desires concerning life-sustaining treatments, such as resuscitation efforts and artificial nutrition, should they find themselves in a terminal condition or a state of permanent unconsciousness. By clearly outlining these preferences, the Living Will helps ensure that a person's values and choices are respected, even when they cannot speak for themselves. It also provides peace of mind to both individuals and their loved ones, alleviating the burden of making difficult decisions during emotionally charged times. Understanding the nuances of this form, including the necessary signatures and potential witnesses, is essential for anyone considering this important aspect of health care planning.
Preview - New York Living Will Form
New York Living Will Declaration
This Living Will Declaration is made in accordance with the New York Health Care Proxy Law (Article 29-C of the New York State Public Health Law). It is a legal document that outlines one's desires regarding medical treatment in circumstances where they are unable to communicate their decisions.
Please complete the following with your personal information to ensure your health care wishes are respected and followed.
Personal Information
Full Legal Name: _______________________________________________
Birth Date: ______________________
Address: _________________________________________________________
City: _____________________ State: NY Zip Code: ___________
Telephone Number: ______________________________________________
Health Care Wishes
This section should clearly state your wishes regarding the withholding or withdrawal of life-sustaining treatment and other specific treatments you do or do not want in case you have a terminal condition, are in a permanent unconscious condition, or in other circumstances you specify.
Life-Sustaining Treatment
In the event that I am in a terminal condition, permanently unconscious, or otherwise unable to communicate my preferences for treatment, my wishes concerning life-sustaining treatment are as follows:
- __________________________________________________________
- __________________________________________________________
- __________________________________________________________
Other Specific Wishes
I also wish to provide the following directions concerning my health care: (e.g., pain relief, antibiotics, etc.)
- __________________________________________________________
- __________________________________________________________
- __________________________________________________________
Health Care Proxy
I designate the following person as my health care agent to make any and all health care decisions for me, consistent with my wishes as stated in this document or as otherwise known to my agent:
Agent's Full Name: _______________________________________________
Relation to Me: __________________________________________________
Agent's Address: _________________________________________________
Agent's Telephone Number: ________________________________________
Alternate Agent
If my primary health care agent is unable, unwilling, or unavailable to act on my behalf, I designate the following person as my alternate health care agent:
Alternate Agent's Full Name: ______________________________________
Relation to Me: __________________________________________________
Alternate Agent's Address: _______________________________________
Alternate Agent's Telephone Number: _______________________________
Signature
I affirm that this document expresses my desires concerning my health care decisions. I understand the full import of this declaration, and I am emotionally and mentally competent to make this declaration.
Signature: _______________________________ Date: ________________
Witness: _________________________________________________________
I declare that the person who signed this document is personally known to me and appears to be of sound mind and acting willingly and free from duress. They declared to me that this document expresses their health care wishes.
Signature of Witness: _______________________________ Date: ________________
This document should be kept in a safe but accessible place. Copies should be provided to the named health care agent, alternate agent, personal physician, and any health care institution expected to be involved in one's care.
PDF Specifications
| Fact Name | Details |
|---|---|
| Definition | A New York Living Will is a legal document that outlines an individual's preferences for medical treatment in the event they become unable to communicate their wishes. |
| Governing Law | The New York Living Will is governed by the New York Public Health Law, specifically Article 29-CC. |
| Eligibility | Any adult who is 18 years or older can create a Living Will in New York, ensuring their healthcare decisions are respected. |
| Execution Requirements | The document must be signed and dated in the presence of two witnesses who are not related to the individual or beneficiaries of their estate. |
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