District of Columbia Living Will Template
This Living Will is created in accordance with the laws of the District of Columbia. It outlines your wishes regarding medical treatment in the event you become unable to communicate your decisions.
Personal Information
- Name: ___________________________
- Date of Birth: _____________________
- Address: __________________________
- City, State, Zip: _________________
- Phone Number: ____________________
Declaration
I, ___________________________, being of sound mind, willfully and voluntarily make this declaration to be followed if I become unable to communicate my wishes regarding medical treatment.
Medical Treatment Preferences
If I am diagnosed with a terminal condition or am in a persistent vegetative state, I wish to make the following preferences known:
- Do not resuscitate me if my heart stops or I stop breathing.
- Do not provide artificial nutrition or hydration if I am unable to eat or drink.
- Provide me with pain relief, even if it may hasten my death.
- Other wishes: ______________________________________.
Appointment of Health Care Agent
If I am unable to make decisions about my medical care, I appoint the following person as my health care agent:
- Name: ___________________________
- Address: ________________________
- Phone Number: ___________________
Signature
By signing below, I affirm that I understand the contents of this Living Will and that it reflects my wishes.
Signature: ___________________________
Date: ________________________________
Witnesses
This Living Will must be witnessed by two individuals who are not related to me and who will not benefit from my estate.
- Witness 1: ______________________ Date: _______________
- Witness 2: ______________________ Date: _______________
It is recommended to keep this document in a safe place and to provide copies to your health care agent and medical providers.