Washington Living Will Template
This document is prepared in accordance with the Washington Natural Death Act, RCW 70.122.030, which allows an adult of sound mind to direct the withholding or withdrawal of life-sustaining treatment if such a person is in a terminal condition or permanent unconscious condition.
Please fill in the following information to specify your wishes regarding life-sustaining treatment.
Personal Information
- Full Name: _______________________________________________
- Date of Birth: ___________________________________________
- Address: _________________________________________________
- City: ______________________ State: WA Zip: ______________
Living Will Statements
- I, _______________________ [Name], resident of __________________________ [Address], City of ___________________ [City], in the State of Washington, being of sound mind, willfully and voluntarily make known my desire that my dying shall not be artificially prolonged under the circumstances set forth below. I hereby declare that:
- If I am in a terminal condition, I direct that life-sustaining treatment be withheld or withdrawn. I want to be allowed to die naturally and only be given treatment that will keep me comfortable and relieve pain, including any medication, while allowing my natural death to occur.
- If I am in a permanent unconscious condition and there is no reasonable hope of recovery, I direct that life-sustaining treatment be withheld or withdrawn. I do not wish to receive nutrition or hydration artificially.
Signature
I understand the full import of this living will, and I am emotionally and mentally competent to make this declaration.
- Signature: ___________________________________________ Date: _________________
- Print Name: __________________________________________
Witnesses
The undersigned affirm that the declarant is personally known to us, signed this living will in our presence, and appears to be of sound mind and not under duress, fraud, or undue influence.
- Witness 1 Signature: ___________________________________ Date: _________________
- Print Name: ____________________________________________
- Address: ________________________________________________
- ___________________________________________________________________________
- Witness 2 Signature: ___________________________________ Date: _________________
- Print Name: ____________________________________________
- Address: ________________________________________________
- ___________________________________________________________________________