Massachusetts Living Will Template
This Living Will is designed to express your wishes regarding medical treatment in Massachusetts. This document is important for guiding your healthcare providers and loved ones in making decisions about your care if you are unable to communicate.
Declarant Information:
- Name: __________________________
- Address: ________________________
- City, State, Zip: _______________
- Date of Birth: __________________
Declaration:
I, the undersigned, declare that if I become unable to make healthcare decisions for myself due to illness or incapacity, I wish to that my wishes regarding medical treatment be followed as outlined below:
- I do not wish to have my life artificially prolonged if I am suffering from a terminal condition or if I am in a persistent vegetative state.
- I authorize the withholding or withdrawal of life-sustaining treatment, including but not limited to:
- Mechanical ventilation
- Dialysis
- Cardiopulmonary resuscitation (CPR)
- Tube feeding
- I wish to receive care that is focused on comfort and dignity for the remainder of my life.
Signature: ______________________________________
Date: __________________________________________
Witnesses: This declaration must be signed in the presence of two witnesses who are not related to you or your healthcare providers.
- Witness 1 Signature: _______________________ Date: _____________
- Witness 2 Signature: _______________________ Date: _____________
This document reflects my preferences for medical treatment in accordance with Massachusetts law. It supersedes any prior living wills or advance directives I may have created.