Living Wills

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Allows an individual to decide ahead of time what should be done for their health in the event they no longer can make decisions because of illness or incapacity.

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A Living Will is a document that allows an individual to give decide ahead of time, what should be done for their health, in the event they no longer can make decisions because of illness or incapacity. For example a living will can give instructions about treatments that should be or should not be pursued by health care providers or caregivers. Although this is a very important document to have, as many as 60% of Americans still do not have a Living Will. Get one today.

Our Living Will form can be used by an adult to direct the withholding, withdrawal or providing of life-prolonging procedures if this adult ever has a terminal or end-state condition, or is in a persistent vegetative state. You may generally revoke a Living Will.

A Living Will can sometimes be part of an Advance Health Care Directive. It is not the same as a Health Care Power of Attorney which allows another person to make medical decisions on your behalf.

Some of the important provisions included in this Living Will are:
  • Living Will: Allows you to state your wishes in the event you become terminally ill, injured, or permanently unconscious
  • Signature: Confirms that these are the wishes of the person whose name appears on the document.
  • Witnesses: Declares that the person whose name is on the document is of sound mind.
This form prepared by lawyers includes:
  1. Information, Instructions and Statutory References for the Living Will
  2. State Specific Living Will Form
State Law Compliant This form is specifically designed for use in every state.
Number of Pages8
DimensionsDesigned for Letter Size (8.5" x 11")
EditableYes (.doc, .wpd and .rtf)
UsageUnlimited number of prints
Product number#29465
This is the content of the form and is provided for your convenience. It is not necessarily what the actual form looks like and does not include the information, instructions and other materials that come with the form you would purchase. An actual sample can also be viewed by clicking on the "Sample Form" near the top left of this page.
















Living Will
(Ohio)















This Packet Includes:
1. Instructions & Checklist
2.   General Information
3.   Living Will for the State of Ohio


Instructions & Checklist


Living Will for the State of Ohio

q   Declarant (Party signing the Living Will) should go over every provision thoroughly and make sure there are no provisions inconsistent with their wishes.

q   Declarant will need to sign the Living Will in the presence of two witnesses. The witnesses will need to sign the Living Will as well.

q   Two people who are willing to serve as the health care proxies will need to sign the document as well. This is someone who is designated to make healthcare decisions on your behalf.  

q   Declarant should retain the original document.  It is a good idea to give copies of the signed Living Will to anyone who might need it in the future, such as your family and your doctors.  

q   Laws vary from time to time and from state to state. These forms are not intended to be and are not a substitute for legal advice. These forms should only be a starting point for you and should not be used or signed before first consulting with an attorney to ensure that it addresses your particular situation. An attorney should be consulted before negotiating any document with another party. 

q   The purchase and use of these forms is subject to the “Disclaimers and Terms Use” found at www.findlegalforms.com.















General Information
Living Will for the State of Ohio

If you are like most people, this is a topic that is usually avoided. Too often however, people may find themselves in a dire medical situation and unable to speak for themselves.  Sadly, your family members, doctors or even the courts may be called upon to make some very difficult decisions about your well-being.

A living will is a document that a person uses to make their wishes known regarding life extending medical care.  These are also sometimes called advanced directives, or health care directives.  While no one wants to think about the end of their lives, these documents are extremely important - it informs your health care providers and your family of your wishes in the event that you are unable to communicate them.

When do you need this document?

The appropriate time to create this living will for yourself is now, long before you think you will ever need it.  It is best to create these documents while you are healthy, of sound mind and able to give thoughtful consideration to how you want your care to be handled should something happen.

Some people shy away from creating these documents because of the finality of them. Remember, you can always amend your living will as you see fit. Your wishes today may not be the wishes you have ten years from now. You are always free to change the provisions.

The document will go into effect when a doctor determines that you are no longer able to make health care decisions for yourself.  This may be because you lack the mental capacity or you are unable to physically communicate.  

Once created, this document will theoretically be in effect for the rest of your life.  That said, you are free to revoke it or revise it at any time you see fit.  In rare circumstances, the court could step in and revoke your living will if it is contested.  If your document was not properly signed, improperly filled out, or your mental capacity was in question the courts can step in and revoke your living will.

Advantages of a Living Will

There are numerous advantages to having a living will:

1.   

You will have control over your healthcare.  The main advantage here is that you will make your wishes known to your doctors and family, when you cannot speak for yourself.  Some people do not want to be resuscitated, or not receive certain treatments due to religious beliefs.  This document sets it all out in black and white for your family and health care professionals.  



2.   Having a living will reduces the burden on your family.  Dealing with a sick or dying family member is one of the most stressful experiences we endure in life.  By having your decisions already set out, your family is not called upon to make these difficult decisions.  

3.   A living will can save your family from a huge financial burden.  Lets say you do not have a living will, are in the hospital and your medical situation is one where you require continuous medical treatment to stay alive.  This could go on indefinitely, and you would incur a massive medical bill which your family will ultimately have to deal with.  A living will could prevent a huge financial burden being placed on your family.


Ohio Law Governing Health Care Directives

This Ohio Living Will is based on Title 21 Chapter 2133 Section 2133.01 et. Seq. of the Ohio Revised Code. For your convenience, we have included useful excerpts from the Ohio Statutes relating to Living Wills.

2133.02 Declaration governing use or continuation, or withholding or withdrawal, of life-sustaining treatment; refusal to comply.

 (A)(1) An adult who is of sound mind voluntarily may execute at any time a declaration governing the use or continuation, or the withholding or withdrawal, of life-sustaining treatment. The declaration shall be signed at the end by the declarant or by another individual at the direction of the declarant, state the date of its execution, and either be witnessed as described in division (B)(1) of this section or be acknowledged by the declarant in accordance with division (B)(2) of this section. The declaration may include a designation by the declarant of one or more persons who are to be notified by the declarant's attending physician at any time that life-sustaining treatment would be withheld or withdrawn pursuant to the declaration. The declaration may include a specific authorization for the use or continuation or the withholding or withdrawal of CPR, but the failure to include a specific authorization for the withholding or withdrawal of CPR does not preclude the withholding or withdrawal of CPR in accordance with sections 2133.01 to 2133.15 or sections 2133.21 to 2133.26 of the Revised Code.





 (2) Depending upon whether the declarant intends the declaration to apply when the declarant is in a terminal condition, in a permanently unconscious state, or in either a terminal condition or a permanently unconscious state, the declarant's declaration shall use either or both of the terms "terminal condition" and "permanently unconscious state" and shall define or otherwise explain those terms in a manner that is substantially consistent with the provisions of section 2133.01 of the Revised Code.

 (3)(a) If a declarant who has authorized the withholding or withdrawal of life-sustaining treatment intends that the declarant's attending physician withhold or withdraw nutrition or hydration when the declarant is in a permanently unconscious state and when the nutrition and hydration will not or no longer will serve to provide comfort to the declarant or alleviate the declarant's pain, then the declarant shall authorize the declarant's attending physician to withhold or withdraw nutrition or hydration when the declarant is in the permanently unconscious state by doing both of the following in the declaration:

 (i) Including a statement in capital letters or other conspicuous type, including, but not limited to, a different font, bigger type, or boldface type, that the declarant's attending physician may withhold or withdraw nutrition and hydration if the declarant is in a permanently unconscious state and if the declarant's attending physician and at least one other physician who has examined the declarant determine, to a reasonable degree of medical certainty and in accordance with reasonable medical standards, that nutrition or hydration will not or no longer will serve to provide comfort to the declarant or alleviate the declarant's pain, or checking or otherwise marking a box or line that is adjacent to a similar statement on a printed form of a declaration;
 (ii) Placing the declarant's initials or signature underneath or adjacent to the statement, check, or other mark described in division (A)(3)(a)(i) of this section.

 (b) Division (A)(3)(a) of this section does not apply to the extent that a declaration authorizes the withholding or withdrawal of life-sustaining treatment when a declarant is in a terminal condition. The provisions of division (E) of section 2133.12 of the Revised Code pertaining to comfort care shall apply to a declarant in a terminal condition.



 (B)(1) If witnessed for purposes of division (A) of this section, a declaration shall be witnessed by two individuals as described in this division in whose presence the declarant, or another individual at the direction of the declarant, signed the declaration. The witnesses to a declaration shall be adults who are not related to the declarant by blood, marriage, or adoption, who are not the attending physician of the declarant, and who are not the administrator of any nursing home in which the declarant is receiving care. Each witness shall subscribe the witness' signature after the signature of the declarant or other individual at the direction of the declarant and, by doing so, attest to the witness' belief that the declarant appears to be of sound mind and not under or subject to duress, fraud, or undue influence. The signatures of the declarant or other individual at the direction of the declarant under division (A) of this section and of the witnesses under this division are not required to appear on the same page of the declaration.



 (2) If acknowledged for purposes of division (A) of this section, a declaration shall be acknowledged before a notary public, who shall make the certification described in section 147.53 of the Revised Code and also shall attest that the declarant appears to be of sound mind and not under or subject to duress, fraud, or undue influence.
 
 (C) An attending physician, or other health care personnel acting under the direction of an attending physician, who is furnished a copy of a declaration shall make it a part of the declarant's medical record and, when section 2133.05 of the Revised Code is applicable, also shall comply with that section.

 (D)(1) Subject to division (D)(2) of this section, an attending physician of a declarant or a health care facility in which a declarant is confined may refuse to comply or allow compliance with the declarant's declaration on the basis of a matter of conscience or on another basis. An employee or agent of an attending physician of a declarant or of a health care facility in which a declarant is confined may refuse to comply with the declarant's declaration on the basis of a matter of conscience.

 (2) If an attending physician of a declarant or a health care facility in which a declarant is confined is not willing or not able to comply or allow compliance with the declarant's declaration, the physician or facility promptly shall so advise the declarant and comply with the provisions of section 2133.10 of the Revised Code, or, if the declaration has become operative as described in division (A) of section 2133.03 of the Revised Code, shall comply with the provisions of section 2133.10 of the Revised Code.

 (E) As used in this section, "CPR" has the same meaning as in section 2133.21 of the Revised Code.






 § 2133.03 When declaration becomes operative; declaration supersedes general consent to treatment, DNR identification or durable power of attorney for health care.

 (A)(1) A declaration becomes operative when it is communicated to the attending physician of the declarant, the attending physician and one other physician who examines the declarant determine that the declarant is in a terminal condition or in a permanently unconscious state, whichever is addressed in the declaration, the applicable requirements of divisions (A)(2) and (3) of this section are satisfied, and the attending physician determines that the declarant no longer is able to make informed decisions regarding the administration of life-sustaining treatment. When the declaration becomes operative, the attending physician and health care facilities shall act in accordance with its provisions or comply with the provisions of section 2133.10 of the Revised Code.

 (2) In order for a declaration to become operative in connection with a declarant who is in a permanently unconscious state, the consulting physician associated with the determination that the declarant is in the permanently unconscious state shall be a physician who, by virtue of advanced education or training, of a practice limited to particular diseases, illnesses, injuries, therapies, or branches of medicine or surgery or osteopathic medicine and surgery, of certification as a specialist in a particular branch of medicine or surgery or osteopathic medicine and surgery, or of experience acquired in the practice of medicine or surgery or osteopathic medicine and surgery, is qualified to determine whether the declarant is in a permanently unconscious state.
  
 (3) In order for a declaration to become operative in connection with a declarant who is in a terminal condition or in a permanently unconscious state, the attending physician of the declarant shall determine, in good faith, to a reasonable degree of medical certainty, and in accordance with reasonable medical standards, that there is no reasonable possibility that the declarant will regain the capacity to make informed decisions regarding the administration of life-sustaining treatment.
  


 (B)(1)(a) A declaration supersedes any general consent to treatment form signed by or on behalf of the declarant prior to, upon, or after the declarant's admission to a health care facility to the extent there is a conflict between the declaration and the form, even if the form is signed after the execution of the declaration. To the extent that the provisions of a declaration and a general consent to treatment form do not conflict, both documents shall govern the use or continuation, or the withholding or withdrawal, of life-sustaining treatment and other medical or nursing procedures, treatments, interventions, or other measures in connection with the declarant. Division (B)(1)(a) of this section does not apply if a declaration is revoked pursuant to section 2133.04 of the Revised Code after the signing of a general consent to treatment form.


  
 (b) A declaration supersedes a DNR identification, as defined in section 2133.21 of the Revised Code, of the declarant that is based upon a prior inconsistent declaration of the declarant or that is based upon a do-not-resuscitate order, as defined in section 2133.21 of the Revised Code, that a physician has issued for the declarant and that is inconsistent with the declaration.
 
 (2) If a declarant has both a valid durable power of attorney for health care and a valid declaration, the declaration supersedes the durable power of attorney for health care to the extent that the provisions of the documents would conflict if the declarant should be in a terminal condition or in a permanently unconscious state. Division (B)(2) of this section does not apply if the declarant revokes the declaration pursuant to section 2133.04 of the Revised Code.
 
 
 § 2133.04 Revocation of declaration.
  
 (A) A declarant may revoke a declaration at any time and in any manner. The revocation shall be effective when the declarant expresses his intention to revoke the declaration, except that, if the declarant made his attending physician aware of the declaration, the revocation shall be effective upon its communication to the attending physician of the declarant by the declarant himself, a witness to the revocation, or other health care personnel to whom the revocation is communicated by such a witness. Absent actual knowledge to the contrary, the attending physician of a declarant and other health care personnel who are informed of the revocation of a declaration by an alleged witness may rely on the information and act in accordance with the revocation.

 (B) Upon the communication as described in division (A) of this section to the attending physician of a declarant of the fact that his declaration has been revoked, the attending physician or other health care personnel acting under the direction of the attending physician shall make the fact a part of the declarant's medical record.
 
 
 § 2133.07 Use of printed form.



 A printed form of a declaration may be sold or otherwise distributed in this state for use by adults who are not advised by an attorney. By use of a printed form of that nature, a declarant may authorize the use or continuation, or the withholding or withdrawal, of life-sustaining treatment should the declarant be in a terminal condition, a permanently unconscious state, or either a terminal condition or a permanently unconscious state, may authorize the withholding or withdrawal of nutrition or hydration should the declarant be in a permanently unconscious state as described in division (A)(3)(a) of section 2133.02 of the Revised Code, and may designate one or more persons who are to be notified by the declarant's attending physician at any time that life-sustaining treatment would be withheld or withdrawn pursuant to the declaration. The printed form shall not be used as an instrument for granting any other type of authority or for making any other type of designation, except that the printed form may be used as a DNR identification if the declarant specifies on the form that the declarant wishes to use it as a DNR identification.



 As used in this section, "DNR identification" has the same meaning as in section 2133.21 of the Revised Code.

.






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Living Will
DECLARATION

Notice to Declarant

This form of a Living Will Declaration is designed to serve as evidence of an individuals desire that life-sustaining medical treatment, including artificially or technologically supplied nutrition and hydration, be withheld or withdrawn if the individual is unable to communicate and is in a terminal condition or a permanently unconscious state.

If you would choose not to withhold or withdraw any or all forms of life sustaining treatment, you have the legal right to so choose and you might want to state your medical treatment preferences in writing in another form of Declaration.

Under Ohio law a Living Will Declaration may be relied on only for individuals in a terminal condition or a permanently unconscious state. If you wish to direct your medical treatment in other circumstances, you should consider preparing a Durable Power of Attorney for Health Care.

Declaration

I, ___________________________________________________________, (name of Declarant) presently residing at ____________________________________________________________, (address) Ohio, being of sound mind and not subject to duress, fraud or undue influence, intending to create a Living Will Declaration under Chapter 2133 et. Seq. of the Ohio Revised Code, do voluntarily make known my desire that my dying shall not be artificially prolonged.

If I am unable to give directions regarding the use of life-sustaining treatment when I am in a terminal condition or a permanently unconscious state, it is my intention that this Living Will Declaration shall be honored by my family and physicians as the final expression of my legal right to refuse medical or surgical treatment. I am a competent adult who understands and accepts the consequences of such refusal and the purpose and effect of this document.

In the event I am in a terminal condition, I declare and direct that my attending physician shall:

 administer no life-sustaining treatment;
 withdraw life-sustaining treatment if such treatment has commenced;

and, permit me to die naturally and provide me with only the care necessary to make me comfortable and to relieve my pain but not to postpone my death.




In the event I am in a permanently unconscious state, I declare and direct that my attending physician shall:

 administer no life-sustaining treatment, except for the provision of artificially or technologically supplied nutrition or hydration unless, in the following paragraph, I have authorized its withholding or withdrawal;
 withdraw such treatment if such treatment has commenced; and,
 permit me to die naturally and provide me with only that care necessary to make me comfortable and to relieve my pain but not to postpone my death.

o  __________ IN ADDITION, IF I HAVE MARKED THE FOREGOING BOX AND HAVE PLACED MY INITIALS ON THE LINE ADJACENTTO IT, I AUTHORIZE MY ATTENDING PHYSICIAN TO WITHHOLD,OR IN THE EVENT THAT TREATMENT HAS ALREADY COMMENCED, TO WITHDRAW THE PROVISION OF ARTIFICIALLY OR TECHNOLOGICALLY SUPPLIED NUTRITION AND HYDRATION, IF I AM IN A PERMANENTLY UNCONSCIOUS STATE AND IF MY ATTENDING PHYSICIAN AND AT LEAST ONE OTHER PHYSICIAN WHO HAS EXAMINED ME DETERMINE, TO A REASONABLE DEGREE OF MEDICAL CERTAINTY AND IN ACCORDANCE WITH REASONABLE MEDICAL STANDARDS, THAT SUCH NUTRITION OR HYDRATION WILL NOT OR NO LONGER WILL SERVE TO PROVIDE COMFORT TO ME OR ALLEVIATE MY PAIN.


Additional Instructions (optional):
____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________


In the event my attending physician determines that life-sustaining treatment should be withheld or withdrawn, he or she shall make a good faith effort and use reasonable diligence to notify one of the persons named below in the following order of priority:

Name 1: ____________________________________________________________________

Relationship: ______________________________________________________________

Address: __________________________________________________________________

______________________________________ Zip Code: ___________________________

Home Phone: _______________________________________________________________

Work Phone: _______________________________________________________________


Name 2: ____________________________________________________________________

Relationship: ______________________________________________________________

Address: __________________________________________________________________

______________________________________ Zip Code: ___________________________

Home Phone: _______________________________________________________________

Work Phone: _______________________________________________________________


For purposes of this Living Will Declaration:

(A) Life-sustaining treatment” means any medical procedure, treatment, intervention, or other measure including artificially or technologically supplied nutrition and hydration that, when administered, will serve principally to prolong the process of dying.

(B) terminal condition” means an irreversible, Incurable, and untreatable condition caused by
Disease, illness, or injury from which, to a reasonable Degree of medical certainty as determined in Accordance with reasonable medical standards by my attending physician and one other physician who has examined me, both of the following apply:

(1) there can be no recovery, and
(2) death is likely to occur within a relatively short time if life-sustaining treatment is not Administered.

(c) permanently unconscious state” means a state of Permanent unconsciousness that, to a reasonable Degree of medical certainty as determined in Accordance with reasonable medical standards by My attending physician and one other physician who Has examined me, is characterized by both of the following:

(1) I am irreversibly unaware of myself and my Environment, and
(2) There is a total loss of cerebral cortical functioning, resulting in my having no capacity to experience pain or suffering.



I understand the purpose and effect of this document and sign my name to this Living Will Declaration after careful deliberation on _______________, (date) at ________________________________ (city), Ohio.


__________________________________________
(Declarants Signature)


I attest that the Declarant signed or acknowledged this Living Will Declaration in my presence, and that the Declarant appears to be of sound mind and not under or subject to duress, fraud or undue influence. I further attest that I am not the attending physician of the Declarant, I am not the administrator of a nursing home in which the Declarant is receiving care, and that I am an adult not related to the Declarant by blood, marriage, or adoption.

_____________________________________________
(Witness 1 Signature)

Print Name: ___________________________________
Address: ______________________________________
Date: _________________________________________


_____________________________________________
(Witness 2 Signature)

Print Name: ___________________________________
Address: ______________________________________
Date: _________________________________________


OR

ACKNOWLEDGEMENT

State of Ohio
County of _______________________________, S.S.:


On this the ____________ day of _______________________, 20 _______, before me, the undersigned Notary Public, personally appeared _____________________________________, (Name of Declarant) known to me or satisfactorily proven to be the Declarant whose name is subscribed to the above Living Will Declaration, and acknowledged that (s)he executed the same for the purposes expressed therein. I attest that the Declarant appears to be of sound mind and not under or subject to duress, fraud or undue influence.


My Commission Expires:


______________________________
(Notary Public)


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