A Texas Living Will form is a legal document that allows individuals to express their wishes regarding medical treatment in the event they become unable to communicate their preferences. This important tool empowers you to make decisions about your healthcare, ensuring that your values and desires are respected. Understanding how to create and utilize this form can provide peace of mind for both you and your loved ones.
In Texas, the Living Will form serves as a crucial document that allows individuals to express their wishes regarding medical treatment in situations where they may no longer be able to communicate their preferences. This form is particularly important for those who wish to outline their desires concerning life-sustaining measures in the event of a terminal illness or irreversible condition. By completing a Living Will, individuals can specify whether they want to receive, withhold, or withdraw medical interventions, such as resuscitation efforts or artificial nutrition and hydration. It is essential to understand that this document only comes into effect when a person is incapacitated and unable to voice their decisions. Additionally, the Texas Living Will form requires signatures from the individual and, in some cases, witnesses to ensure its validity. By taking the time to complete this form, individuals can provide clarity and peace of mind for their loved ones, guiding them through difficult decisions during challenging times.
Texas Living Will Declaration
Pursuant to the Texas Advance Directives Act (Health and Safety Code, Chapter 166), this Living Will Declaration allows you to express your wishes regarding medical treatment in the event that you are diagnosed with a terminal condition or an irreversible condition and are unable to make your own health care decisions.
Part I: Declaration of Health Care Directive
I, _______________ [Your Full Name], a resident of _______________ [City/Town], _______________ [County], in the State of Texas, being of sound mind, willfully and voluntarily declare my desire that my dying shall not be artificially prolonged under the circumstances set forth below, and I hereby declare:
If at any time I should have an incurable or irreversible condition that has been diagnosed by two physicians who have examined me, one of whom is my attending physician, and both have concluded that my condition is terminal such that the expectation of death is imminent or that my condition is irreversible such that I will never regain consciousness or the ability to make decisions, I direct that life-sustaining treatments be withheld or removed.
Life-sustaining treatment is understood to include any medical procedure, machine, or medication that sustains, restores, or supplants a vital function. I direct that such treatments be withheld or removed if they only prolong the process of dying or if I am unlikely to regain consciousness or capacity to make health care decisions.
Part II: Power of Attorney for Health Care
I further appoint _______________ [Name of Health Care Agent], residing at _______________ [Address], as my agent to make health care decisions on my behalf if I am incapable of making such decisions. In the event the above-named individual is unwilling or unable to act as my health care agent, I hereby appoint _______________ [Alternate Agent's Name], residing at _______________ [Address], as my alternate health care agent.
The powers conferred on my health care agent include, but are not limited to, the power to consent, refuse consent, or withdraw consent to any and all types of medical care, treatment, surgical procedures, artificial nutrition, and hydration, and palliative care.
Part III: Signature and Acknowledgment
This declaration becomes effective when it is communicated to my attending physician. I understand the full import of this declaration and I am emotionally and mentally competent to make it.
Declared on this ____ day of _______________, 20____.
______________________________________________ [Your Signature]
______________________________________________ [Printed Name]
State of Texas
County of ___________
This document was acknowledged before me on (date) __________ by (name of principal) ____________________________.
______________________________________________ Notary Public, State of Texas My commission expires: __________
Witnesses (Optional)
I declare under penalty of perjury under the laws of Texas that the principal appears to be of sound mind and under no duress, fraud, or undue influence. I am not the person appointed as agent or alternate agent by this document.
Witness #1 Signature: ___________________________________ Date: _________ Printed Name: ___________________________________________
Witness #2 Signature: ___________________________________ Date: _________ Printed Name: ___________________________________________
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