Massachusetts Living Will
This Living Will is made in accordance with the laws of the Commonwealth of Massachusetts.
I, [Your Full Name], born on [Your Date of Birth], residing at [Your Address], do hereby declare this to be my Living Will.
In the event that I become unable to communicate my wishes regarding medical treatment, I wish to express my preferences for such treatment.
1. Medical Treatment Preferences
If I am in a terminal condition or a state of permanent unconsciousness, I do not want the following treatments:
- Cardiopulmonary resuscitation (CPR)
- Mechanical ventilation
- Dialysis
- Tube feeding
- Any other life-sustaining treatment that prolongs the dying process
2. Additional Preferences
In addition to the above preferences, I wish to express that:
- If I have a poor prognosis with severe, irreversible illness, I prefer comfort care only.
- I wish to avoid invasive treatments that do not improve my quality of life.
- I would like to have my pain managed as fully as possible.
3. Designation of Healthcare Proxy
I designate the following person as my healthcare proxy:
Name: [Proxy's Full Name]
Relationship: [Relationship to You]
Address: [Proxy's Address]
4. Signatures
Signed on this day: [Date]
Signature: __________________________
Print Name: [Your Full Name]
5. Witnesses
This document must be witnessed by two individuals who are not related to you:
Witness 1: [Witness 1 Full Name], Signature: __________________________
Witness 2: [Witness 2 Full Name], Signature: __________________________
By signing this Living Will, I affirm that I am of sound mind and not under duress.