A West Virginia Living Will is a legal document that allows individuals to outline their preferences for medical treatment in the event they become unable to communicate their wishes. This essential form ensures that your healthcare choices are respected, providing peace of mind for both you and your loved ones. Don’t wait to make your wishes known; fill out the form by clicking the button below.
In the state of West Virginia, the Living Will form serves as a crucial tool for individuals wishing to express their healthcare preferences in the event that they become unable to communicate their wishes. This legal document allows individuals to outline their desires regarding medical treatment, particularly concerning end-of-life care. By completing a Living Will, a person can specify whether they wish to receive life-sustaining treatments, such as resuscitation or mechanical ventilation, should they be diagnosed with a terminal illness or enter a persistent vegetative state. Importantly, the form not only provides clarity for healthcare providers but also alleviates the emotional burden on family members during difficult times. Furthermore, the Living Will can be combined with a Durable Power of Attorney for Healthcare, enabling a designated individual to make decisions on behalf of the person if they are incapacitated. Understanding the nuances of the West Virginia Living Will form is essential for anyone looking to ensure their medical preferences are honored and respected, thereby fostering peace of mind for both the individual and their loved ones.
West Virginia Living Will
This Living Will is designed to be in compliance with the West Virginia Health Care Decisions Act. It allows you, the undersigned, to instruct your family, doctors, and other health care providers about your wishes regarding medical treatment and life-sustaining measures in the event that you are unable to communicate your decisions due to illness or incapacity.
1. Information of the Principal
Full Name: ___________________________________
Date of Birth: ________________________________
Address: _____________________________________
City: __________________ State: WV Zip:_________
Telephone Number: ____________________________
2. Declaration
I, ________________ [insert your name], resident of ______________ [insert your city], West Virginia, being of sound mind, willfully and voluntarily make known my desire that my dying should not be artificially prolonged under the circumstances set forth below. I hereby declare:
3. Life-Sustaining Treatment Preferences
In the event I am in a terminal condition, persistent vegetative state, or in an end-stage condition, as these terms are defined by the West Virginia Health Care Decisions Act, I direct that:
4. Additional Instructions
You may add additional instructions, including your preferences regarding artificially provided nutrition, hydration, and other treatments not specified above.
___________________________________________________________________________________________________
5. Signature and Acknowledgment
This Living Will shall remain in effect until I revoke it. I understand the full importance of this declaration and am emotionally and mentally competent to make this decision.
______________________________________
Signature of the Principal Date
State of West Virginia )
County of _______________ )
Sworn to and subscribed before me this _____ day of ___________, 20___.
Notary Public
My Commission Expires: __________________
6. Witness Statement
I declare that the principal appears to be of sound mind and not under duress, fraud, or undue influence and that I am not the person appointed as the attorney-in-fact by this document, nor am I the principal’s health care provider or an employee of the health care provider.
Witness 1 Signature: _________________________
Date: _____________________________________
Witness 2 Signature: _________________________
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