Structure
In Louisiana, the Living Will form plays a crucial role in ensuring that individuals can express their healthcare preferences in advance, particularly in situations where they may be unable to communicate their wishes. This legal document allows you to outline your desires regarding medical treatment and life-sustaining measures, guiding healthcare providers and loved ones in making decisions that align with your values. The form typically includes specific instructions about the types of medical interventions you do or do not want, such as resuscitation efforts, artificial nutrition, and hydration. Importantly, it also designates a trusted individual, often referred to as a healthcare proxy or agent, who can advocate on your behalf if you are incapacitated. By completing a Living Will, you not only provide clarity for your family during challenging times but also ensure that your autonomy and preferences are respected, reinforcing the importance of proactive planning in healthcare decisions.
Sample - Louisiana Living Will Form
Louisiana Living Will Template
This Living Will is designed to be in compliance with the Louisiana Declarations Concerning Life-Sustaining Procedures Act. It is a legal document that outlines the preferences for medical treatment of the person executing the document, known herein as the "Principal," in the event that they become unable to communicate their healthcare decisions due to incapacity.
Please fill in the blanks with the appropriate information to personalize this document.
Principal’s Information:
- Name: ___________________________________________
- Date of Birth: __________________________________
- Address: ________________________________________
- City, State, ZIP: _______________________________
- Phone Number: ___________________________________
Declaration:
I, _________________, being of sound mind, willfully and voluntarily make known my wishes concerning my medical care, including my acceptance or refusal of medical treatment or procedures that might extend my life.
In the event that I am unable to communicate my healthcare preferences due to any form of incapacity, I direct that my healthcare providers and family or other representatives follow the instructions as outlined in this Living Will.
Directions Concerning Life-Sustaining Treatment:
I direct that my healthcare providers:
- ___ Administer, withhold, or withdraw treatment in a manner consistent with my directions below.
- ___ Do not administer treatment that only serves to prolong the process of dying if I am in a terminal and irreversible condition.
- ___ Do provide treatment that alleviates pain and provides comfort, even if such treatment may extend my life.
Additional Instructions:
(Optional)______________________________________________________________________________________________
__________________________________________________________________________________________________________
This declaration shall remain in effect until I revoke it, notwithstanding my subsequent disability or incapacity.
Signature: _______________________________
Date: _____________
Witnesses:
The declaration must be signed in the presence of two witnesses, who must also sign the document.
Witness 1:
- Name: ___________________________________________
- Signature: ______________________________________
- Date: ___________________________________________
Witness 2:
- Name: ___________________________________________
- Signature: ______________________________________
- Date: ___________________________________________
Document Details
| Fact Name | Description |
|---|---|
| Purpose | A Louisiana Living Will allows individuals to express their wishes regarding medical treatment in case they become unable to communicate their preferences. |
| Governing Law | This form is governed by Louisiana Revised Statutes, specifically R.S. 40:1151.2. |
| Eligibility | Any adult who is at least 18 years old and of sound mind can create a Living Will in Louisiana. |
| Witness Requirement | The Living Will must be signed in the presence of two witnesses or notarized to be valid. |
| Revocation | Individuals can revoke their Living Will at any time, as long as they communicate their decision clearly. |
Some Other Louisiana Templates
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