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Living Will

Making Health Care Decisions

Making health care decisions is an important right for patients and their families.

Every adult of sound mind has the right to be told about the nature of their condition, the general nature of proposed treatment and alternate procedures available.

To help with these decisions the State of Louisiana has enacted the following laws for Advanced Directives for Health Care:

The first, the Durable Mandate for Health Care Decisions lets you appoint someone to make health care decisions for you when you cannot make them for yourself. It allows the patient’s substitute to give or withhold consent to any medical treatment.

The second, the Natural Death Act enables qualified persons to make a Declaration (Living Will) which lets you specify what treatments you would not want for an incurable or irreversible illness. It allows you to “speak directly” to your physician, even after you cannot speak. A living will applies only to life sustaining (extraordinary) procedures, and then only in situations involving an incurable or irreversible condition.

These documents are available to all patients or responsible parties at the time of admission.


LIVING WILL

Declaration made this ________day of __________(month, year).

I, ____________, 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 and do hereby declare:

If at any time I should have an incurable injury, disease or illness, or be in a continual profound comatose state with no reasonable chance of recovery, certified to be a terminal and irreversible condition by two physicians who have personally examined me, one of whom shall be my attending physician, and the physicians have determined that my death will occur whether or not life-sustaining procedures are utilized and where the application of life-sustaining procedures would serve only to prolong artificially the dying process, I direct that such procedures be withheld or withdrawn and that I be permitted to die naturally with only the administration of medication or the performance of any medical procedure deemed necessary to provide me with comfort care.

In the absence of my ability to give directions regarding the use of such life-sustaining procedures, it is my intention that this declaration shall be honored by my family and physician(s) as the final expression of my legal right to refuse medical or surgical treatment and accept the consequences of such refusal.

I understand the full import of this declaration and I am emotionally and mentally competent to make this declaration.

Signed__________________________

Resident of ______________________(City, Parish, State)

The declarant has been personally known to me and I believe him or her to be of sound mind.

Witness_______________________

Witness_______________________

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