Homepage Living Will Template for the State of New York
Jump Links

Making decisions about healthcare can be quite daunting, especially when considering future scenarios where one may not be able to communicate their wishes directly due to illness or incapacity. In New York, residents have the option to prepare for such situations through a Living Will, a document that allows individuals to outline their preferences for medical treatment in the event that they are unable to make decisions for themselves. This powerful tool not only ensures that a person's healthcare wishes are known and considered but also provides peace of mind to both the individual and their loved ones, knowing that these tough decisions were made ahead of time. The form covers a range of medical directives, from the extent of life-sustaining treatment desired to the refusal of specific types of medical intervention. It's key for residents to familiarize themselves with the specifics of New York's Living Will form to ensure their future healthcare preferences are respected and legally recognized.

New York Living Will Sample

New York Living Will Declaration

This Living Will Declaration is made in accordance with the New York Health Care Proxy Law (Article 29-C of the New York State Public Health Law). It serves as a directive for the provision, withholding, or withdrawal of life-sustaining treatment and artificially provided nutrition and hydration if I am unable to make my own healthcare decisions.

Part I: Information of the Declarant

Name of Declarant: ___________________________________________

Date of Birth: ___________________

Address: _____________________________________________________

City: ___________________________ State: NY Zip: ______________

Part II: Appointment of a Health Care Agent

I, _________________________, being of sound mind, hereby designate the following individual as my Health Care Agent to make any and all health care decisions for me, including decisions to provide, withhold, or withdraw artificial nutrition and hydration, and any other treatments or procedures that could keep me alive, in the event I am unable to make my own health care decisions.

Name of Health Care Agent: _____________________________________

Relationship to Declarant: ____________________________________

Address: _____________________________________________________

Phone Number: ___________________ Email: ______________________

Part III: Alternate Health Care Agent (Optional)

If my Health Care Agent is unwilling, unable, or ineligible to act as my agent, I designate the following individual as my alternate Health Care Agent:

Name of Alternate Health Care Agent: ____________________________

Relationship to Declarant: _____________________________________

Address: ______________________________________________________

Phone Number: __________________ Email: _______________________

Part IV: Directions Regarding Health Care

  1. I do not want life-sustaining treatment if I am in a terminal condition, in a permanent coma, or in a persistent vegetative state with no reasonable expectation of recovery.
  2. I do not want to receive artificially provided fluids and nutrition.
  3. I wish to receive all possible treatments to extend my life for as long as possible within the limits of generally accepted health care standards.
  4. Other directions: __________________________________________________________

Part V: Organ and Tissue Donation (Optional)

I wish to donate only the following organs or tissues: ______________________________

I wish to donate any needed organs or tissues.

I do not wish to make an organ or tissue donation.

Part VI: Signature

I understand the contents of this document and I declare that I am emotionally and mentally competent to make this Living Will. This Living Will represents my wishes as to my health care. It revokes any prior Living Will that I have made.

Signature of Declarant: ______________________________________ Date: ______________

Print Name: __________________________________________________

Part VII: Witness Affirmation

Two adult witnesses must sign below, affirming that the declarant is known to them, signed this document in their presence, and appears to be of sound mind and not under duress, fraud, or undue influence.

Witness 1 Signature: ________________________________________ Date: ______________

Print Name: __________________________________________________

Witness 2 Signature: ________________________________________ Date: ______________

Print Name: __________________________________________________

PDF Form Information

Fact Description
1. Purpose A New York Living Will allows an individual to outline their healthcare preferences in situations where they are unable to communicate or make decisions for themselves.
2. Also Known As It is sometimes referred to as an "Advance Directive".
3. Legal Authority While New York does not have a statute that specifically authorizes living wills, they are recognized by state courts as valid expressions of one's health care preferences.
4. Required Witnesses Although not statutorily required, it is advisable to have the living will witnessed by two individuals who are not beneficiaries.
5. Combining with Health Care Proxy It is common to accompany a Living Will with a Health Care Proxy form, appointing an agent to make health care decisions on one's behalf.
6. Key Components Typical components include preferences about artificial life support, feeding tubes, resuscitation, and organ donation.
7. When It Becomes Effective A Living Will becomes effective when the author can no longer make or communicate decisions regarding their own medical care.
8. Revocation The document can be revoked at any time by the author, as long as they are mentally competent.
9. Legal Precedents The recognition of Living Wills in New York is supported by case law, rather than specific legislation.
10. Importance of Specificity The clarity and specificity of instructions within the Living Will are crucial for its interpretation and implementation by healthcare providers.

New York Living Will: Usage Guidelines

After deciding to establish a New York Living Will, the next step is to carefully complete the form. This document is vital as it will communicate your wishes regarding medical treatment in the event you are unable to express your decisions due to illness or incapacity. Filling out the form accurately is paramount to ensure your health care preferences are respected and followed. Below, you will find step-by-step instructions designed to guide you through this process.

  1. Begin by reading the entire form thoroughly to understand the scope of decisions you need to make about your healthcare.
  2. Clearly print your full legal name at the top of the form to identify yourself as the principal making the health care decisions.
  3. Specify your wishes regarding the initiation, refusal, or withdrawal of life-sustaining treatment, including artificial respiration, cardiopulmonary resuscitation (CPR), and artificial nutrition and hydration. Consider all possible health scenarios in which you would want or not want these types of interventions.
  4. In the sections provided, detail any additional treatments or procedures you do or do not want under certain circumstances. Be as specific as possible to avoid any ambiguity about your healthcare preferences.
  5. Appoint a Health Care Agent by providing the name, relationship, address, and contact number of the person you trust to make health care decisions on your behalf if you are unable to do so. This step is optional but recommended.
  6. Review your state’s requirements for witnessing or notarizing the document, as this can vary. Ensure the signing process is completed in accordance with New York law to make your Living Will legally binding.
  7. Sign and date the document in the presence of two witnesses, and have them sign it as well. The witnesses should not be individuals who are named as your Health Care Agent or those who stand to inherit from your estate.
  8. After completing the form, make several copies. Keep the original in a safe but accessible place. Provide copies to your Health Care Agent (if you designated one), family members, your primary care physician, and any other healthcare providers to ensure your wishes are respected.

\ Once the New York Living Will form is fully completed and properly signed, your health care preferences will be documented and accessible to those who may need to refer to them. Remember, this form can be updated or revoked by you at any time, should your wishes or circumstances change. It’s advisable to review this document periodically and discuss your decisions with your healthcare providers and loved ones to ensure they remain current with your healthcare goals.

FAQ

  1. What is a New York Living Will?

    A Living Will in New York is a legal document that outlines your preferences for medical treatment if you become unable to make decisions for yourself. It comes into play in situations where you're terminally ill, in a persistent vegetative state, or severely incapacitated.

  2. Who should have a Living Will?

    Any adult over the age of 18 who wants to have control over their medical treatment in case they become unable to communicate their wishes should consider creating a Living Will. It's particularly important for those with strong preferences about life-sustaining treatments or end-of-life care.

  3. How do I create a Living Will in New York?

    To create a Living Will in New York, you should draft a document stating your health care wishes, specifically regarding life-sustaining treatment. New York does not have a statutory form, so it's advised to consult with an attorney to ensure your Living Will complates with current laws and fully expresses your wishes. Once drafted, it must be signed in the presence of two witnesses.

  4. Do I need an attorney to create a Living Will?

    While New York doesn't legally require an attorney to create a Living Will, consulting with one can help ensure your document is clear, comprehensive, and complies with state laws. An attorney can also help you consider scenarios and options you might not have thought of on your own.

  5. What should be included in a Living Will?

    Your Living Will should clearly state your preferences for medical treatments in various scenarios, including life-sustaining treatment options like artificial hydration and nutrition. It can also specify wishes for pain relief and other palliative care, even if those measures do not prolong life.

  6. Can I change my Living Will?

    Yes, you can change your Living Will at any time. To amend your Living Will or create a new one, you must follow the same process as creating the original, including having your new document witnessed properly. It's also important to communicate any changes to your health care proxy, family, and health care providers.

  7. What is the difference between a Living Will and a Health Care Proxy?

    A Living Will focuses on your medical treatment preferences in end-of-life and permanently unconscious situations. A Health Care Proxy, on the other hand, designates someone to make health care decisions on your behalf in scenarios not covered by your Living Will. They often work hand-in-hand, providing comprehensive guidance for your care.

  8. Is a Living Will the same as a Do Not Resuscitate (DNR) order?

    No, a Living Will is not the same as a Do Not Resuscitate (DNR) order. A Living Will provides broad directives about your health care preferences, including but not limited to life-sustaining treatment. A DNR specifically instructs health care providers not to perform CPR if your breathing stops or if your heart stops beating.

  9. When does my Living Will become effective?

    Your Living Will becomes effective when you are unable to communicate your health care decisions, as determined by a physician. It guides your medical team and loved ones in making decisions about your care according to your wishes.

  10. How can I ensure that my Living Will is followed?

    To ensure your Living Will is followed, provide copies to your health care proxy, family members, and health care providers. Discuss your wishes with them so they understand your preferences clearly. It's also a good idea to review and update your Living Will periodically to ensure it reflects your current wishes.

Common mistakes

Filling out a New York Living Will form is an important step for many people, ensuring their healthcare wishes are respected even when they can't communicate them directly. However, mistakes can be made during this process that might impact the effectiveness of the document. Here are four common errors to be aware of:

  1. Not being specific enough about medical treatments. Many individuals might neglect to provide detailed instructions about their healthcare preferences in their Living Will. It's crucial to be clear about which treatments you would or wouldn't want under different medical scenarios. The absence of specifics can leave healthcare providers and loved ones guessing, which might result in receiving treatment that goes against your wishes.
  2. Failing to update the document. Life circumstances and medical opinions change over time, but people often forget to update their Living Wills to reflect these changes. It's essential to review and revise your document after major life events, such as the birth of a child, divorce, or a significant change in health status, to ensure it still represents your current wishes.
  3. Not discussing the contents with loved ones. Although it might be challenging, it's important to have conversations with family members and other loved ones about the choices made in your Living Will. Not doing so can lead to misunderstandings or conflicts during stressful times when the document needs to be enacted. Clear communication ensures everyone understands your wishes and can act accordingly.
  4. Improper signing and witnessing. For a Living Will to be legally valid in New York, it must be correctly signed and witnessed as per state requirements. A common mistake is not adhering to these legal formalities, which can render the document unenforceable. Ensuring that all legal requirements are met, including the number of witnesses or notarization if applicable, is critical for the document's validity.

Being mindful of these common mistakes can help ensure that your Living Will accurately reflects your healthcare wishes and can be effectively carried out. It's always wise to seek guidance from a professional familiar with New York law to avoid potential pitfalls and ensure your document is properly completed and maintained.

Documents used along the form

When preparing for the future, particularly in regards to health care decisions, many individuals opt to complete a Living Will. This document allows you to express your wishes on how you want to be treated in situations where you're unable to make decisions for yourself. However, a comprehensive approach to future healthcare planning often involves more than just this single form. To ensure that all aspects are covered, several additional documents are typically utilized alongside the New York Living Will. Below is a list of some of these crucial documents, each serving its unique purpose in safeguarding one's healthcare preferences and legal rights.

  • Health Care Proxy Form – This form appoints someone you trust to make health care decisions on your behalf if you're unable to do so. Unlike the Living Will, which is more about documenting specific treatment preferences, the Health Care Proxy appoints an agent, giving them the authority to make decisions across a range of medical situations based on your directives or, when not specified, in your best interest.
  • Durable Power of Attorney – While similar to a Health Care Proxy, a Durable Power of Attorney is broader, granting someone you designate the power to make decisions beyond health care, including financial and legal ones, should you become incapacitated.
  • Medical Orders for Life-Sustaining Treatment (MOLST) – This document is intended for patients with serious health conditions and spells out specific instructions regarding treatments that can sustain life. These decisions are based on discussions between the patient (or their designated health care proxy) and their health care provider, focusing on the patient's current health status and treatment preferences.
  • Do Not Resuscitate (DNR) Order – Separate from a Living Will, a DNR order is a medical order signed by a health care provider that instructs health care professionals not to perform cardiopulmonary resuscitation (CPR) if a patient's breathing stops or if the patient’s heart stops beating. It is usually for patients with severe conditions whose health would not improve from CPR.
  • HIPAA Authorization Form – This form grants permission for health care providers to share your health information with designated individuals, such as family members or other loved ones. It's crucial for ensuring that the people involved in your care, and those you’ve appointed to make decisions on your behalf, have access to the information they need to make informed decisions about your health care.

Completing a Living Will and the accompanying documents is a proactive step toward ensuring your health care preferences are known and respected. Each document serves a complementary role, covering different aspects of your health care decisions and legal rights. Together, they provide a comprehensive framework for your future health care, offering peace of mind to you and your loved ones. It's advisable to consult with legal counsel specializing in estate planning or health care law to ensure that all paperwork accurately reflects your wishes and complies with New York State laws.

Similar forms

The New York Living Will shares similarities with the Health Care Proxy, as both documents allow individuals to outline their preferences for medical treatment and care. A Health Care Proxy specifically appoints someone to make healthcare decisions on behalf of the person if they become unable to make those decisions themselves. Unlike a Living Will, which primarily documents specific wishes regarding life-sustaining treatment, a Health Care Proxy designates a decision-maker, combining authority with specific guidance.

Similar to the New York Living Will, a Durable Power of Attorney for Health Care is another document focusing on healthcare decisions. It goes beyond the scope of a standard Living Will by not only specifying wishes regarding medical treatment but also granting a trusted individual, known as an agent, broad authority to make health care decisions when the creator is incapacitated. This includes decisions not specifically mentioned in the Living Will, providing more holistic coverage of unexpected situations.

The Advance Directive serves a function akin to the New York Living Will, encapsulating both instructions for future medical care and the appointment of a health care agent. This comprehensive document merges aspects of the Living Will and Health Care Proxy, ensuring that a person's healthcare preferences are respected, and there's someone legally authorized to advocate for these preferences, thereby offering a two-pronged approach to planning for medical incapacity.

A Medical Orders for Life-Sustaining Treatment (MOLST) form also parallels the New York Living Will in purpose. It is designed for patients with serious health conditions and outlines specific instructions for health care providers about life-sustaining treatments. While a Living Will expresses wishes for future consideration, a MOLST form translates those wishes into medical orders that are immediately actionable, ensuring that the patient's treatment preferences are followed in real-time clinical situations.

The Do Not Resuscitate (DNR) order is another document related to the New York Living Will. It specifically addresses one aspect of end-of-life care—whether or not to perform CPR if breathing or heartbeat stops. A Living Will may include a DNR order among its directives, but the DNR is a more narrowly focused document, typically used in medical settings to inform healthcare professionals of a patient’s wishes regarding CPR.

Comparable to a New York Living Will, a Five Wishes Document is an advanced directive that goes beyond health care decisions to include personal, emotional, and spiritual wishes. It allows individuals to specify their desires about the type of care they want to receive at the end of life, including comfort care, how they wish to be treated, and what they want their loved ones to know, thus providing a more comprehensive approach to end-of-life planning.

The Power of Attorney (POA) shares some parallels with the New Living Will, albeit in a broader context. While a Living Will primarily deals with health care decisions near or at the end of life, a POA can grant an agent the authority to make a wide range of decisions on behalf of the principal, including financial, legal, and property matters, in addition to health care decisions, depending on the type of POA executed.

A POLST (Physician Orders for Life-Sustaining Treatment) form, similar to a New York Living Will, is used to document a patient's preferences for life-sustaining treatments, including resuscitation, intubation, and use of ventilators. It is intended for seriously ill patients and translates individuals’ end-of-life wishes into medical orders, ensuring those wishes are executed exactly as intended.

The Last Will and Testament, while primarily concerned with the distribution of a person's assets after death, shares a fundamental objective with the New York Living Will: to ensure an individual's wishes are known and respected upon their incapacity or death. While the Last Will addresses asset distribution, the Living Will focuses on healthcare decisions, echoing the broad goal of proactive planning and personal autonomy.

Finally, the Ethics Declaration, or Living Ethical Will, is a document that, like the New York Living Will, reflects personal values and life lessons rather than healthcare or financial directives. It allows individuals to leave behind a statement of their ethical beliefs and wishes for their loved ones, serving as a guide for how to live in accordance with those values, and complementing the practical directives contained in a Living Will.

Dos and Don'ts

When filling out the New York Living Will form, it's crucial to keep certain dos and don'ts in mind to ensure your healthcare wishes are clearly expressed and legally sound. The following list outlines key points to consider:

Do:
  1. Read through the entire form before starting to fill it out, to understand all the sections and requirements.

  2. Clearly state your healthcare preferences, especially regarding life-sustaining treatment and end-of-life care.

  3. Use specific medical terms if possible, to avoid any ambiguity about your wishes.

  4. Discuss your wishes with your healthcare provider and a trusted family member or friend who can act as your healthcare agent.

  5. Sign and date the form in the presence of two witnesses, ensuring they meet New York State requirements for witnessing a Living Will.

Don't:
  • Leave any sections blank; if a section doesn’t apply, clearly mark it as "N/A" or "Not Applicable" to show that you didn't overlook it.

  • Rely solely on verbal instructions to your family or healthcare providers. Verbal wishes can be forgotten, misunderstood, or disputed.

  • Forget to review and update your Living Will periodically. Life changes, such as a new diagnosis or a change in your healthcare preferences, might necessitate adjustments to your document.

  • Assume that the Living Will is valid in other states. If you spend a lot of time in another state, check that state’s requirements to ensure your wishes are respected there as well.

Misconceptions

When discussing the New York Living Will form, several misconceptions often arise. It's important to address these misunderstandings clearly to ensure individuals are fully informed about the implications and capabilities of Living Wills in New York State.

  • Only for the Elderly: A common misconception is that Living Wills are only for the elderly. In reality, any adult over the age of 18 can and should consider making a Living Will. This document is crucial for outlining your healthcare preferences in situations where you cannot communicate your wishes due to incapacity or illness.

  • Legally Complex: Many people mistakenly believe that creating a Living Will is a complicated legal process. However, New York State provides straightforward guidelines for drafting a Living Will. While legal advice can be beneficial, especially in complex cases, the process itself is designed to be accessible.

  • Covers All Medical Decisions: There's a misconception that a Living Will covers all medical decisions. In fact, it specifically addresses end-of-life care and treatment preferences. For a broader scope of medical decision-making power, one would need a Health Care Proxy in addition to a Living Will.

  • Overrides Health Care Proxy: Another misunderstanding is that a Living Will overrides a Health Care Proxy. Actually, these documents can complement each other. The Living Will provides guidance to the Health Care Proxy, who is then empowered to make decisions aligning with the documented wishes of the incapacitated individual.

  • Permanent and Unchangeable: Many believe once a Living Will is signed, it cannot be altered. This is not correct. A Living Will can be revised or revoked at any time, provided the individual is mentally competent. It's wise to review and possibly update this document periodically as circumstances and preferences evolve.

  • Effective Immediately upon Signing: It's a common belief that a Living Will goes into effect immediately after it is signed. In truth, it only becomes operational when the person becomes incapacitated and unable to communicate their healthcare wishes. Until such a time, the individual's spoken wishes take precedence over the document.

Key takeaways

When individuals contemplate the uncertain future, one of the prudent steps they might consider is drafting a Living Will. Particularly in New York, understanding how to properly fill out and use the Living Will form is crucial. This document, essentially a directive, allows individuals to outline their preferences for medical treatment in the event that they are unable to communicate those decisions themselves due to illness or incapacity. Below are several key takeaways to guide individuals through the process of effectively utilizing the New York Living Will form.

  • Before filling out the form, one must thoroughly understand its purpose. The Living Will is designed to convey instructions regarding one's medical treatment preferences, including the refusal or request of life-sustaining treatment, under certain medical conditions where the individual is unable to make decisions.
  • The form requires the individual's clear and specific instructions regarding their health care preferences. This specificity includes decisions regarding the use of life-sustaining treatments, such as artificial hydration and nutrition, mechanical ventilation, and other forms of medical intervention.
  • Choosing a health care agent is not a requirement of the Living Will in New York, but it is highly recommended. While the Living Will speaks to specific scenarios, a health care proxy can make decisions in real time, covering aspects not specifically mentioned in the document. This person should be trusted to understand and advocate for the individual's preferences.
  • Witnesses are essential for the validity of the Living Will in New York. The form must be signed in the presence of two adult witnesses who are not beneficiaries of the person's estate and do not have a vested interest in their death. These witnesses must also sign the document, attesting to the individual's state of mind and voluntary nature of their decisions.
  • Once completed, copies of the Living Will should be distributed strategically. The individual's physician, health care proxy, and close family members or friends should have copies. This ensures that the document can be easily accessed and referenced in an emergency.
  • It is imperative to review and update the Living Will periodically. As circumstances and preferences change, the document should reflect these adjustments to remain an accurate expression of the individual’s wishes. Changes in health condition, family dynamics, or medical innovation may all prompt a review of the document.

Understanding these key elements can substantially impact the effectiveness of a New York Living Will, ensuring that the individual’s health care preferences are respected and followed. It's not only about making decisions for the future but also about communicating these preferences clearly and ensuring they are legally recognized and executable. The process demands careful thought, clear communication, and proper legal formalities.

Please rate Living Will Template for the State of New York Form
4.77
Excellent
231 Votes