New York Living Will
This Living Will has been
prepared to conform to the law in the State of New York, as set
forth in the case In re Westchester County Medical Center, 72
NY2d 517 (1988). In that case the Court established the need for
"clear and convincing" evidence of a patient's wishes and stated
that the "ideal situation is one in which the patient's wishes
were expressed in some form of writing, perhaps a 'living will."
I, Mr. John Peter Smith, of 123 Main Street, New York, New
York, 90210, United States, being of sound mind, make this
statement as a directive to be followed if I become permanently
unable to participate in decisions regarding my medical care.
These instructions reflect my firm and settled commitment to
decline medical treatment under the circumstances indicated
I direct my attending physician to withhold or withdraw
treatment that merely prolongs my dying, if I should be in an
incurable or irreversible mental or physical condition with no
reasonable expectation of recovery.
These instructions apply if I am (a)
in a terminal condition; (b) permanently unconscious;
or (c) if I am minimally conscious but have irreversible
brain damage and will never regain the ability to make decisions
and express my wishes.
I direct that my treatment be limited to measures to keep me
comfortable and to relieve pain, including any pain that might
occur by withholding or withdrawing treatment.
While I understand that I am not legally required to be
specific about future treatments if I am in the condition(s)
described above I feel especially strongly about the following
forms of treatment:
I do not want cardiac resuscitation.
I do not want mechanical respiration.
I do not want artificial nutrition and hydration.
I do want maximum pain relief, even if it may hasten my
These directions express my legal right to refuse treatment,
under the law of New York. I intend my instructions to be
carried out, unless I have rescinded them in a new writing or by
clearly indicating that I have changed my mind.
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