Delaware Living Will Template
This document serves as a Living Will, specifically crafted in accordance with the laws of the State of Delaware, allowing an individual to outline their care preferences in circumstances where they are no longer able to communicate their decisions due to illness or incapacity.
Personal Information
Full Name: ________________________________________
Date of Birth: ____________________________________
Address: __________________________________________
City: __________________State: DE Zip: ____________
Healthcare Directives
In the event that I am unable to make my own healthcare decisions, I provide the following instructions that are to be carried out by my designated healthcare representative, physicians, and any other healthcare providers.
- Life-Sustaining Treatment: In the situation where I am in a terminal condition, and the use of life-sustaining procedures would only serve to artificially prolong the dying process, I direct that such procedures be withheld or withdrawn. My preference is:
a) To receive all available life-sustaining treatments.
b) Not to receive life-sustaining treatments, other than those required to alleviate pain.
c) Other specific wishes: _______________________________________
- Artificial Nutrition and Hydration: In the case of a terminal condition or permanent unconsciousness where I cannot survive without artificially provided nutrition and hydration, my directive is:
a) To receive artificially provided nutrition and hydration.
b) Not to receive artificially provided nutrition and hydration.
c) Other specific wishes: _______________________________________
- Pain Management: Regardless of my condition, I wish to receive treatment to alleviate pain and ensure my comfort, even if such treatment may indirectly shorten my life, hasten my death, or affect my appetite or breathing. My preference regarding pain management is as follows:
a) I prioritize maximum comfort over prolonging life.
b) I prefer a balance between comfort and extended life.
c) Other specific preferences: ______________________________
Signature
By signing below, I affirm that I thoroughly understand the contents of this Living Will, and that I am emotionally and mentally competent to make these wishes known. I also affirm that this declaration accurately reflects my wishes regarding my healthcare and treatment preferences.
Signature: ___________________________ Date: ________________________
Print Name: ___________________________
Witness
I declare that the individual who signed 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 appointed agent, nor am I the individual’s healthcare provider or an employee of a healthcare facility in which the individual is a patient.
Witness Signature: _____________________ Date: ________________________
Print Name: ___________________________
State of Delaware Acknowledgment
This Living Will is made in accordance with the Delaware Advance Healthcare Directive Act, ensuring that the individual's rights to make decisions about their healthcare are respected and protected.