Texas Living Will
This Living Will is created in accordance with Texas law and outlines your wishes regarding medical treatment in the event you are unable to communicate those wishes yourself.
Personal Information
- Full Name: ____________________________
- Date of Birth: ______________________
- Address: ____________________________
- City, State, Zip Code: ________________
Declaration
I, ____________________________, being of sound mind, voluntarily make this declaration while I am of sound mind and in full understanding of its purpose.
Healthcare Instructions
If I am diagnosed with a terminal condition or if I am in a persistent vegetative state, I direct that:
- I do not want life-sustaining treatment that only prolongs the process of dying.
- I want to receive comfort care and measures to keep me comfortable.
- Should I require pain relief, I request medication even if it may hasten my death.
Appointment of Agent
If I am unable to make healthcare decisions, I appoint the following person as my agent:
- Name: ________________________________
- Address: ____________________________
- Phone Number: ______________________
Revocation of Prior Living Wills
This document revokes any prior Living Wills executed by me.
Signatures
By signing below, I am expressing my wishes regarding medical treatment as described above.
- Signature: ___________________________ Date: ______________
Witness Information
This Living Will must be witnessed by two individuals who are not related to me or entitled to my estate.
- Witness 1 Name: ____________________________
- Witness 2 Name: ____________________________
Each witness must sign below:
- Signature of Witness 1: ___________________
- Signature of Witness 2: ___________________
This Living Will becomes effective upon my inability to make healthcare decisions as determined by my attending physician.