Massachusetts Living Will Template
This Living Will is designed to express the desires of the person (hereinafter referred to as the "Principal") regarding their medical treatment in circumstances where they are no longer able to communicate these wishes themselves. This document is in compliance with the relevant laws of the State of Massachusetts, ensuring that the Principal's specific healthcare wishes are acknowledged and respected.
Principal's Information:
Full Name: ___________________________________________
Date of Birth: _________________________________________
Address: _____________________________________________
In the event that I, ____________________ [Principal's full name], become incapacitated and am unable to express my wishes concerning my healthcare, I direct the following to be my desires:
- Life-Sustaining Treatment: In case I am in a terminal condition, where the application of life-sustaining treatment would only serve to artificially prolong the process of dying, I direct that such treatment be withheld or withdrawn. I wish to be allowed to die naturally with only the administration of medication or the performance of any medical procedure deemed necessary to provide me with comfortable care.
- Artificial Nutrition and Hydration: If I am in a persistent vegetative state or terminal condition, I express my wish that artificial nutrition and hydration be withheld or withdrawn, unless my doctor believes that this would cause me discomfort or pain.
- Pain Relief: I direct that I be kept as free from pain and suffering as possible through the administration of medication or any other measures, even if such actions hasten my death.
Healthcare Proxy: I designate the following individual as my Healthcare Proxy to make healthcare decisions for me should I become incapable of making my decisions:
Name: _______________________________________________
Relationship to the Principal: _____________________________
Address: _____________________________________________
Phone Number: ________________________________________
If the above-named proxy is unable, unwilling, or unavailable to act as my Healthcare Proxy, I designate the following alternate:
Name: _______________________________________________
Relationship to the Principal: _____________________________
Address: _____________________________________________
Phone Number: ________________________________________
This Living Will reflects my firm and settled commitment to decline life-sustaining treatment under the circumstances indicated above. I am emotionally and mentally competent to make this will, and I understand its full import.
Signature of Principal: _______________________________ Date: _________________
Witness Declaration
We declare that the Principal appears to be emotionally and mentally competent to make this Living Will and that they signed this document in our presence:
Witness 1 Signature: _______________________________ Date: _________________
Printed Name: _____________________________________
Address: ___________________________________________
Witness 2 Signature: _______________________________ Date: _________________
Printed Name: _____________________________________
Address: ___________________________________________