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New York ________________________________ _____________________________________________ (Witness Signature) Print Name: ___________________________________ Address: ______________________________________ 2 state of the Declarant, nor am I a health care agent of the Declarant. _____________________________________________ (Witness Signature) Print Name: ___________________________________ Address: ______esence of the Declarant. I did not sign the Declarant's signature above for or at the direction of the Declarant. At the date of this instrument, I am not a beneficiry entitled to any portion of the end. I saw the Declarant sign the declaration in my presence (or the Declarant acknowledged in my presence that he or she had signed the declaration) and I signed the declaration as a witness in the pr________________________________________ ______________________________________ Zip Code: ___________________________ The Declarant is personally known to me and I believe him or her to be of sound miunderstand the full import of this declaration. Date: _________________________________ Signature: _________________________________________________________________ Address: __________________________right to refuse treatment, under the law of New York. I intend my instructions to be carried out, unless I have rescinded them in a new writing or by clearly indicating that I have changed my mind. I ___________ ____________________________________________________________________________ ____________________________________________________________________________ These directions express my legal not want antibiotics. However, I do want maximum pain relief, even if it may hasten my death. 1 Additional Instructions (optional): _________________________________________________________________ and initial any statement with which you do not agree): I do not want cardiac resuscitation. I do not want artificial or mechanical respiration. I do not want artificial nutrition and hydration. I donderstand that I am not legally required to be specific about future treatments if I am in the condition(s) described above I feel especially strongly about the following forms of treatment (cross out to the environment I direct that my treatment be limited to measures to keep me comfortable and to relieve pain, including any pain that might occur by withholding or withdrawing treatment. While I ucious I mean that I am in a permanent coma or persistent vegetative state which is an irreversible condition in which I am at no time aware of myself or the environment and show no behavioral responsesible medical condition which, without the administration of life support systems, will, in the opinion of my attending physician, result in death within a relatively short time. By permanently unconsI am minimally conscious but have irreversible brain damage and will never regain the ability to make decisions and express my wishes. By terminal condition, I mean that I have an incurable or irreverincurable or irreversible mental or physical condition with no reasonable expectation of recovery. These instructions apply if I am (a) in a terminal condition; (b) permanently unconscious; or (c) if tled desire to decline medical treatment under the circumstances indicated below: I direct my attending physician to withhold or withdraw treatment that merely prolongs my dying, if I should be in an fully and voluntarily make this statement as a directive to be followed if I become permanently unable to participate in decisions regarding my medical care. These instructions reflect my firm and setthese forms is subject to the Disclaimers and Terms of Use found at findlegalforms.com Living Will DECLARATION I, __________________________________________________________, being of sound mind, willey is always recommended when dealing with estate planning matters. Any possible tax consequences arising out of this document should be discussed with a tax professional. [_] The purchase and use of te. These forms should only be a starting point for you and should not be used or signed without consulting an attorney first to make sure it fits your particular situation. Advice from a local attornny specific purpose or as to their legal effect or completeness. [_]These forms are not intended and are not a substitute for legal and/or tax advice. Laws vary from time to time and from state to staion, of the document. The document does not have to be notarized. [_] These forms are provided "as is" and no implied or express warranties have been made or are provided as to their suitability for adeath). The Witnesses should know the nature of the document being signed and be able to attest that Declarant was of sound mind, under no duress, and understood the nature, and consequences of executre eighteen or over. Neither witness can be a person appointed as a health care agent, or a distributee of the Declarant or beneficiary under his or her Will (so that would benefit by the declarant's hes were expressed in some form of writing like for example a `Living Will Declaration' The Living will should be properly executed by the Declarant and it should also be signed by two witnesses who a In re Westchester County Medical Center the Court established the need for "clear and convincing" evidence of a patient's wishes and stated that the "ideal situation is one in which the patient's wishen he or she cannot personally communicate those wishes. Some of the standards have been set forth in cases like In re Westchester County Medical Center, 72 N.Y.2d 517 (1988) and many other cases. Inatutorily authorized in New York, they are recognized by New York courts as the best evidence of an individual's wishes concerning medical treatment in the event that treatment is proposed at a time wInformation and Instructions New York Living Will This package contains (1) Information and Instruction for New York Living Will; (2) New York Living Will. Although Living Will Declarations are not st New York