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Vermont _______________________________ _______________________________________________________ 18 V.S.A. § 5253. ___________ Witness:________________________________________________________ Copies of this request have been given to: _______________________________________________________ _________________________________________ Signed: ________________________________________________________ Date:__________________________________________________________ Witness:________________________________________________________________________________________________ __________________________________________________________________________________ _________________________________________________________________ enforceable, I hope that those to whom this will is addressed will regard themselves as morally bound by these provisions. Other directions (optional ­ or write none): _______________________________l consideration and is in accordance with my strong convictions and beliefs. I want the wishes and directions here expressed carried out to the extent permitted by law. Insofar as they are not legallyy extraordinary measures. I do, however, ask that medication be mercifully administered to me to alleviate suffering even though this may shorten my remaining life. This statement is made after carefuhe situation should arise in which I am in a terminal state and there is no reasonable expectation of my recovery, I direct that I be allowed to die a natural death and that my life not be prolonged b when I, _________________________________________ , can no longer take part in decisions of my own future, let this statement stand as an expression of my wishes, while I am still of sound mind. If tbe. To any individual who may become responsible for my health, welfare or affairs. Death is as much a reality as birth, growth, maturity and old age-it is the one certainty of life. If the time comese Disclaimers and Terms of Use found at findlegalforms.com Terminal Care Document (Living Will) To my family, my physician, my lawyer, my clergyman. To any medical facility in whose care I happen to n 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 these forms is subject to thbe 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 attorney is always recommended whe 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 state. These forms should only ld only postpone the moment of death. [_] These forms are provided "as is" and no implied or express warranties have been made or are provided as to their suitability for any specific purpose or as tonjury, disease or illness which regardless of the application of life-saving procedures would, within reasonable medical judgment, produce death and where application of life-sustaining procedures wou actively participate in the decision-making process. (4) "Physician" means a medical doctor licensed to practice in the state of Vermont. (5) "Terminal state" means an incurable condition caused by iecuted, contains the express direction that no extraordinary measures be taken when the person executing said document is in a terminal state, without hope of recovery from such state and is unable too artificially postpone the moment of death and where, in the judgment of the attending physician, the patient is in a terminal state. (3) "Terminal care document" means a document which, when duly exwhich utilizes mechanical or other artificial means to sustain, restore, or supplant a vital function which, in the judgment of the attending physician, when applied to the patient, would serve only te physician selected by, or assigned to the patient, who has primary responsibility for the treatment and care of the patient. (2) "Extraordinary measures" means any medical procedure or intervention e document may be revoked only as provided herein. 18 V.S.A. § 5252. (Definitions) The following definitions shall be applicable in the construction of this chapter: (1) "Attending physician" means th or 2, or by burning, tearing or obliterating the same or by causing the same to be done by some other person Information & Instructions ­ Page 2 at his direction and in his presence. A terminal carons of sections 5253 and 5254 of this title may revoke the same orally in the presence of two or more witnesses, at least one of whom shall not be a spouse or a relative as specified in 15 V.S.A. §§ 1erson who has at the time of the witnessing thereof any claims against the estate of the person. 18 V.S.A. § 5257. (Revocation) A person who has validly executed a document consistent with the provisiribing witnesses, none of whom shall be the person's spouse, heir, reciprocal beneficiary, attending physician or person acting under the direction or control of the attending physician or any other pns about his care. 18 V.S.A. § 5254. (Execution and witnesses) The document set forth in section 5253 of this title shall be executed by the person making the same in the presence of two or more subscng that no extraordinary measures be used to prolong his life when he is in a terminal state. The document shall only be effective in the event that the person is incapable of participating in decisiod or withdrawn. 18 V.S.A. § 5253. (Terminal care document) A person of sound mind who is 18 years of age or older may execute at any time a document commonly known as a terminal care document, directiinued with dignity and without pain. A person has a fundamental right to determine whether or not life-sustaining procedures which would cause prolongation of life beyond natural limits, should be usemedical treatment he will receive in the event that his physical state reaches such a point of deterioration that he is in a terminal state and there is no reasonable expectation that life can be contermont Statutes relating to Living Wills. 18 V.S.A. § 5251. (Purpose and policy) The state of Vermont recognizes that a person as a matter of right may rationally make an election as to the extent of minal Care Document (Living Will). This Vermont Terminal Care Document is based on Vermont Statutes Title 18 Chapter 111 Section 5253. For your convenience, we have included useful excerpts from the VInformation and Instructions Vermont Terminal Care Document (Living Will) This package contains (1) Information and Instruction for Vermont Terminal Care Document (a.k.a. Living Will); (2) Vermont Ter Vermont