Washington Living Will Template
This Living Will is created in accordance with the laws of the State of Washington. It serves to outline an individual’s preferences regarding medical treatment and end-of-life care.
Declarant Information:
- Name: ____________________________
- Date of Birth: ____________________
- Address: _________________________
- City: _____________________________
- State: ____________________________
- Zip Code: _________________________
Declarations:
I, the undersigned, declare that if I reach a condition where I am unable to communicate my wishes regarding medical treatment, I do not wish to undergo the following:
- Resuscitation in the event of cardiac arrest.
- Mechanical ventilation if I cannot breathe independently.
- Feeding tubes or intravenous fluids if I am in a terminal state.
Special Instructions:
My wishes regarding medical treatment are as follows:
____________________________________________________
____________________________________________________
Appointment of Agent:
If I become unable to make my own healthcare decisions, I appoint the following individual as my healthcare agent:
- Name: ____________________________
- Address: _________________________
- Phone Number: ____________________
Signature:
I understand that this Living Will expresses my wishes concerning medical treatment and will be honored by my healthcare providers. I willingly make this declaration on this date:
Date: _________________________
Signature: ____________________________
Witnesses:
This declaration must be witnessed by two individuals who are not related to me and who do not stand to inherit from my estate.
- Witness 1 Name: ___________________________
- Witness 1 Signature: ________________________
- Date: _________________________
- Witness 2 Name: ___________________________
- Witness 2 Signature: ________________________
- Date: _________________________
By completing this Living Will, I confirm that I understand its meaning and implications and that it reflects my healthcare preferences.