Alabama Living Will Template
This Alabama Living Will, also referred to as an "Advance Directive", is designed in accordance with the Alabama Advance Directive for Health Care Act. It serves as a legal document allowing you to outline your preferences for medical treatment in the event you are unable to communicate your wishes due to serious illness or incapacity.
Personal Information
- Full Name: ___________________________
- Date of Birth: ________________________
- Address: ______________________________________________
- City: ____________________ State: Alabama Zip: _________
- Phone Number: ________________________
Directions for Health Care
I, ________________________ (insert your name), being of sound mind, hereby direct that my health care providers and others involved in my care follow the instructions provided in this living will. If at any time I am unable to communicate my wishes directly, the guidelines laid out here should be followed.
It is my intention that this document provides clear and convincing evidence of my wishes concerning the withholding or withdrawal of life-sustaining treatment and artificially provided nutrition and hydration.
- Lack of Decisional Capacity: A determination must be made by my attending physician and one other qualified physician that I am no longer able to make, understand, or communicate decisions regarding my medical care.
- Terminal Condition: If I am in a terminal condition where the application of life-sustaining treatment would only prolong the dying process, I elect the following (initial one):
- ____ Withhold or withdraw treatment that only prolongs the dying process.
- ____ Provide all treatment reasonably available, regardless of my condition.
- Permanently Unconscious (Persistent Vegetative State): If I am determined to be in a persistent vegetative state (permanently unconscious) and there is no reasonable expectation of recovery:
- ____ I do not want life-sustaining treatment, except as needed for comfort care.
- ____ I want all treatment options provided or continued.
Artificial Nutrition and Hydration
As to artificial nutrition and hydration, if in a condition described above, I direct the following (initial one):
- ____ Withhold artificially provided foods and fluids, apart from comfort care.
- ____ Provide artificially provided foods and fluids.
Signature
I understand the full import of this document and I am emotionally and mentally competent to make this directive. I also understand that I can revoke this directive at any time.
______________________
Signature
______________________
Date
Witness Statement
I declare that the individual who signed or acknowledged this document is personally known to me and appears to be of sound mind and under no duress, fraud, or undue influence. I am not the individual's attending physician, an employee of the attending physician, nor do I have any claim against the individual's estate upon death.
______________________
Signature of Witness
______________________
Printed Name of Witness
______________________
Date