Tennessee Living Will Template
This Living Will is made pursuant to the laws of the State of Tennessee, specifically designed to outline your wishes regarding medical treatment in the event that you become unable to communicate those wishes yourself.
By signing this document, you state your preferences regarding life-sustaining treatment under the circumstances outlined herein.
Personal Information
- Name: _______________________
- Date of Birth: ________________
- Address: ______________________
- City: _________________________
- State: ________________________
- Zip Code: _____________________
Living Will Declaration
I, the undersigned, declare that if I am diagnosed with a terminal condition, or if I am in a persistent vegetative state, I do not wish to receive the following treatments:
- Cardiopulmonary resuscitation (CPR)
- Mechanical ventilation
- Feeding tubes
- Dialysis
- Any other life-sustaining treatment not mentioned above
Should I be in such a condition, I prefer to receive comfort care that alleviates pain and offers dignity in my final days.
Designation of Healthcare Agent (Optional)
If I am unable to make my own healthcare decisions, I wish to designate the following individual to act on my behalf:
- Name of Agent: _________________________
- Relationship to Me: ___________________
- Phone Number: ________________________
Signatures
This Living Will requires my signature and the signature of a witness to be valid.
Signed: _______________________________ (Your Signature)
Date: _________________________________
Witnesses
I hereby affirm that I am not the individual designated as healthcare agent or related by blood or marriage to the individual making this Living Will.
- Witness Name: ________________________ Signature: ______________________
- Witness Name: ________________________ Signature: ______________________
This document serves to communicate your wishes regarding medical treatment and should be kept in a safe place, with copies provided to your healthcare agent and family members.