Outline
In Indiana, the Living Will form plays a crucial role in healthcare planning, allowing individuals to express their wishes regarding medical treatment in situations where they cannot communicate those wishes themselves. This legal document outlines the types of medical interventions one may or may not want if faced with a terminal illness or a state of permanent unconsciousness. By completing a Living Will, individuals can ensure that their preferences for life-sustaining treatments, such as resuscitation and mechanical ventilation, are known and respected. It also provides peace of mind to both the individual and their loved ones, as it alleviates the burden of making difficult decisions during emotional times. Understanding the specific requirements for completing and executing this form is essential, as it must comply with Indiana state laws to be valid. By being informed about the Living Will process, individuals can take proactive steps in managing their healthcare choices and ensuring their voices are heard, even when they cannot speak for themselves.
Form Sample
Indiana Living Will Declaration
This Living Will Declaration is made in accordance with the Indiana Living Will Act, Ind. Code §§ 16-36-4-1 et seq., by the undersigned declarant to guide the provision, withholding, or withdrawal of life-prolonging procedures in the event of a terminal condition. This document is legally binding and shall communicate the declarant's wishes should they become unable to participate in medical treatment decisions.
Declarant Information:
- Full Name: ________________________________________
- Date of Birth: ________________________________________
- Address: ________________________________________
- City, State, Zip: ________________________________________
- Primary Phone: ________________________________________
Declaration:
I, ________________ [insert full name], being of sound mind, willfully and voluntarily declare that if at any time I should have an incurable injury, disease, or illness certified to be a terminal condition by two physicians who have examined me, one of whom is my attending physician, and those physicians determine that my death is imminent and that the application of life-prolonging procedures would serve only to artificially prolong the dying process, I direct that such procedures be withheld or withdrawn, and that I be permitted to die naturally with only the administration of medication or the performance of any medical procedure deemed necessary to provide me with comfortable care.
I further declare that this Living Will shall remain in effect until I revoke it.
No agent or surrogate has been authorized to make this declaration on my behalf. This declaration reflects my personal, individual, conscious will and is made after careful consideration.
Signature:
____________________________________________
Date: _______________________
Witness Declaration:
We, the undersigned witnesses, each declare under the penalty of perjury under the laws of Indiana that, to the best of our knowledge, the declarant is an adult of sound mind and under no constraint or undue influence. We are not the declarant's attending physician, an employee of the attending physician or health care facility in which the declarant is a patient, or directly financially responsible for the declarant's medical care. We are not related to the declarant by blood, marriage, or adoption, and to the best of our knowledge, we are not beneficiaries of the declarant's estate under any will or by operation of law.
- Witness 1 Name: ________________________________________
- Witness 1 Signature: ________________________________________
- Witness 1 Date: ________________________________________
- Witness 2 Name: ________________________________________
- Witness 2 Signature: ________________________________________
- Witness 2 Date: ________________________________________
Document Details
| Fact Name | Details |
|---|---|
| Purpose | The Indiana Living Will form allows individuals to express their wishes regarding medical treatment in the event they become unable to communicate their preferences. |
| Governing Law | The form is governed by Indiana Code Title 16, Article 36, Chapter 4. |
| Eligibility | Any adult resident of Indiana can complete a Living Will to outline their healthcare preferences. |
| Signing Requirements | The form must be signed by the individual in the presence of two witnesses or a notary public. |
| Witness Restrictions | Witnesses cannot be related to the individual by blood or marriage, nor can they be beneficiaries of the individual's estate. |
| Revocation | An individual can revoke their Living Will at any time, provided they communicate their decision clearly. |
| Storage | It is advisable to keep the Living Will in a safe place and provide copies to family members and healthcare providers. |
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