Fillable Printable Living Will Form Texas

Living Will Form Texas

Living will (male)

I, __________________________, of __________________________, being of sound

mind, do hereby willfully and voluntarily make known my desire that my life not be prolonged

under any of the following conditions, and do hereby further declare:

1. If I should, at any time, have an incurable condition caused by any disease or illness,

or by any accident or injury, and be determined by any two or more physicians to be in a terminal

condition whereby the use of "heroic measures" or the application of life-sustaining procedures

would only serve to delay the moment of my death, and where my attending physician has

determined that my death is imminent whether or not such "heroic measures" or life-sustaining

measures are employed, I direct that such measures and procedures be withheld or withdrawn

and that I be permitted to die naturally.

2. In the event of my inability to give directions regarding the application of life-

sustaining procedures or the use of "heroic measures", it is my intention that this directive shall

be honored by my family and physicians as my final expression of my right to refuse medical and

surgical treatment, and my acceptance of the consequences of such refusal.

3. I am mentally, emotionally and legally competent to make this directive and I fully

understand its import.

4. I reserve the right to revoke this directive at any time.

5. This directive shall remain in force until revoked.

IN WITNESS WHEREOF, I have hereto set my hand and seal this _____ day___ of

______________, 20_____.

_______________________________

Declaration of Witnesses

The declarant is personally known to me and I believe him to be of sound mind and

emotionally and legally competent to make the herein contined Directive to Physicians. I am not

related to the declarant by blood or marriage, nor would I be entitled to any portion of the

declarant's estate upon his decease, nor am I an attending physician of the declarant, nor an

employee of the attending physician, nor an employee of a health care facility in which the

declarant is a patient, nor a patient in a health care facility in which the declarant is a patient, nor

am I a person who has any claim against any portion of the estate of the declarant upon his

death.

________________________________ ______________________________

NOTICE

The information in this document is designed to provide an outline that you can follow

when formulating business or personal plans. Due to the variances of many local, city, county

and state laws, we recommend that you seek professional legal counseling before entering into

any contract or agreement.