Blank Living Will Template for the State of Louisiana Open Editor Now

Blank Living Will Template for the State of Louisiana

A Louisiana Living Will form is a legal document that allows individuals to outline their preferences regarding medical treatment in the event that they are unable to make decisions for themselves. This crucial form serves as a guide for family members and healthcare providers, ensuring that a person's healthcare choices are respected even when they are not in a position to communicate them directly. For those looking to secure their healthcare wishes in Louisiana, taking the step to fill out this form is a proactive measure towards peace of mind.

To start securing your healthcare preferences today, click the button below to fill out your Louisiana Living Will form.

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Contents

In the state of Louisiana, people have the opportunity to express their wishes about medical treatment through a document known as a Louisiana Living Will form. This crucial legal document becomes especially significant when individuals face health conditions that prevent them from making their decisions known. It allows for the specification of what medical actions should be taken in the event that a person is no longer able to express their wishes due to incapacitation. Covering a range of decisions from the use of life-sustaining treatments to end-of-life care, the Louisiana Living Will ensures that the medical preferences of individuals are recognized and respected by healthcare providers and family members alike. Not only does it provide peace of mind for the person who creates the will, but it also guides family members during challenging times by clearly outlining the person's health care preferences, thus reducing uncertainties and potential conflicts about medical decisions. As a legal instrument, it has specific requirements, including how it must be signed and witnessed, to ensure its validity. By understanding the major aspects of the Louisiana Living Will form, individuals can take an informed step towards advocating for their healthcare wishes and ensuring their rights are protected even when they can no longer voice them personally.

Louisiana Living Will Sample

Louisiana Living Will Template

This Living Will is made in accordance with the Louisiana Declarations Concerning Life-Sustaining Procedures Act, La. Rev. Stat. Ann. §§ 40:1299.58.1-40:1299.58.10, and expresses the desires of the undersigned regarding health care decisions and the withholding or withdrawal of life-sustaining procedures.

Part I: Information of the Declarant

Full Name: ___________________________________________

Date of Birth: ________________________________________

Social Security Number: _______________________________

Address: _____________________________________________

City: ________________________ State: LA Zip: ___________

Phone Number: ________________________________________

Part II: Declaration

I, _________________ [insert name], being of sound mind and not under duress, fraud, or undue influence, hereby declare my wishes regarding the withholding or withdrawal of life-sustaining procedures should I become incapacitated and unable to communicate my desires for myself.

Part III: Life-Sustaining Treatment Preferences

In the event that I am in a terminal and irreversible condition, I direct that:

  1. All treatments other than those necessary for my comfort or alleviation of pain be discontinued or withheld.
  2. Life-sustaining procedures be withheld or withdrawn to permit a natural death.
  3. Nutritional and hydration support be provided or withheld in accordance with my physician's recommendation.

Part IV: Special Directives or Limitations

Please specify any special directives or limitations concerning the treatments to be provided, withheld, or withdrawn:

_________________________________________________________________

_________________________________________________________________

Part V: Appointment of Health Care Representative

I hereby designate the following individual as my health care representative to make health care decisions for me if and when I become unable to make health care decisions for myself:

Name: ________________________________________________________

Relationship: _________________________________________________

Phone Number: ________________________________________________

Alternate Phone Number: ________________________________________

If my primary representative is unable or unwilling to act on my behalf, I designate the following individual as an alternate representative:

Name: ________________________________________________________

Relationship: _________________________________________________

Phone Number: ________________________________________________

Alternate Phone Number: ________________________________________

Part VI: Signature

In witness whereof, I have signed this Living Will on this day of ______________ (month, day, year).

______________________________________

Signature of the Declarant

State of Louisiana

Parish of ________________________

This document was signed in my presence by ___________________________ [insert name of declarant] who is of sound mind and free of duress and undue influence.

Date: ________________________

Witness 1: ____________________________________________________

Print Name: __________________________________________________

Witness 2: ____________________________________________________

Print Name: __________________________________________________

Form Details

Fact Number Detail
1 The Louisiana Living Will is governed by the Louisiana Revised Statutes, specifically under Title 40:1299.58.1-1299.58.10.
2 It allows individuals to declare their wishes regarding life-sustaining treatments in the event they are unable to make decisions for themselves.
3 Individuals can specify their preferences about the use or refusal of life-sustaining treatments and artificially provided nutrition and hydration.
4 The document requires the signature of the person making the declaration (declarant) and must be witnessed by two adults.
5 A Living Will becomes effective when the declarant is diagnosed as having a terminal and irreversible condition, certified by two physicians.
6 Individuals have the right to revoke their Living Will at any time, in any manner that communicates their intent to revoke, without regard to mental or physical condition.
7 The form does not require notarization in Louisiana, which makes it more accessible to a wider audience.
8 Healthcare providers are legally obliged to follow the directives laid out in a valid Living Will, except in certain circumstances such as conflicting with their medical judgment or policies.

Guidelines on Utilizing Louisiana Living Will

Creating a Living Will in Louisiana is a proactive step towards ensuring your healthcare preferences are respected and followed, especially during times when you might not be able to communicate your wishes. It allows you to specify the kinds of medical treatment you do or do not want to receive if you're unable to make decisions due to illness or incapacity. Completing this form might seem daunting at first, but by following a step-by-step guide, the process can be straightforward and stress-free. Here's how to go about filling out the Louisiana Living Will form.

  1. Begin by gathering your personal information, such as your full legal name, date of birth, and address. This will be required to identify you as the declarant (the person making the declaration).
  2. Read the declaration carefully. This section outlines the purpose of the Living Will and provides essential information about the document's legal aspects. Make sure you understand each part before moving on.
  3. Enter your personal details into the designated spaces on the form. Ensure that all the information is accurate and matches the identification documents that might be used to verify your identity.
  4. Specify your healthcare preferences. This might include decisions about life-sustaining treatments, artificial nutrition and hydration, and other end-of-life care options. Be as clear and detailed as possible to avoid any ambiguity.
  5. Appoint a healthcare proxy, if the form allows. This person, also known as a healthcare agent or durable power of attorney for healthcare, will make medical decisions on your behalf if you're unable to do so. Provide the proxy's full name, relationship to you, and contact information.
  6. Review your decisions and preferences with your healthcare provider to ensure they are medically sound and accurately recorded on the form.
  7. Sign and date the form in the presence of two witnesses or a notary public, depending on the requirements of your state. The witnesses must also sign the form, attesting that you are of sound mind and not under duress or undue influence at the time of signing.
  8. Keep the original document in a safe but accessible place. Inform your healthcare proxy (if you have appointed one), family members, and healthcare providers about the existence and location of your Living Will.
  9. Distribute copies of the signed and witnessed Living Will to your healthcare proxy, primary doctor, and any other relevant medical providers or family members who should be aware of your healthcare preferences.

Making a Living Will is a significant step in healthcare planning. It ensures that your medical treatment preferences are honored, providing peace of mind to you and your loved ones. Remember, you can update or revoke your Living Will at any time to reflect your current healthcare wishes. Always consult with a qualified professional if you have questions or need advice specific to your situation.

More About Louisiana Living Will

  1. What is a Louisiana Living Will?

    A Louisiana Living Will is a legal document that allows a person to state their wishes regarding medical treatment if they become unable to communicate their decisions due to a serious condition. It specifically addresses situations where the person is terminally ill or permanently unconscious. This document ensures that an individual's preferences about life-sustaining treatments, including artificial life support and feeding tubes, are known and respected.

  2. Who should have a Louisiana Living Will?

    Any adult in Louisiana who wishes to have control over their medical treatment should consider creating a Living Will. It is especially important for those with strong preferences about end-of-life care or those who wish to relieve their loved ones of making these difficult decisions on their behalf. It’s a way to ensure that your healthcare preferences are honored, regardless of your ability to communicate.

  3. How does one create a Louisiana Living Will?

    To create a valid Louisiana Living Will, the individual must complete a form that meets state-specific requirements. This includes detailing their healthcare decisions, particularly about life-sustaining treatment, and signing the document in the presence of two witnesses. It is recommended to consult with a legal advisor to ensure the document accurately reflects the person's wishes and complies with Louisiana law.

  4. What should be included in a Louisiana Living Will?

    A Louisiana Living Will should clearly state the individual's decisions regarding the use of life-sustaining measures, including ventilation, resuscitation, tube feeding, or any other forms of artificial life support. It should also include personal information, such as the individual’s full name and date of birth, to ensure the document is easily identifiable. Specifying a healthcare proxy, someone trusted to make decisions if the person is unable, can also be part of this document.

  5. Can a Louisiana Living Will be revoked or changed?

    Yes, an individual can revoke or change their Louisiana Living Will at any time, as long as they are of sound mind. This can be done by creating a new Living Will document that reflects the new decisions or by physically destroying the original document. Communicating these changes to the healthcare proxy, family members, and healthcare providers is also crucial to ensure the updated wishes are known and followed.

  6. How does a Louisiana Living Will impact healthcare decisions?

    A Louisiana Living Will provides clear instructions to healthcare providers about the individual’s preferences for end-of-life care. When a person cannot communicate their wishes due to incapacity, the Living Will guides decisions regarding the use or withdrawal of life-sustaining treatments. It helps avoid conflicts among family members by outlining the person’s explicit directives, ensuring their autonomy and dignity are maintained during vulnerable times.

Common mistakes

When it comes to preparing for the future, a Louisiana Living Will form is crucial for stating your wishes regarding medical treatment if you become unable to communicate them yourself. However, even with the best intentions, people can make errors that undermine the effectiveness of this essential document. Here are six common mistakes to avoid:

  1. Not tailoring the document to their specific wishes: Many simply fill in the blanks without considering the nuances of their personal wishes or discussing them with their healthcare provider. This can lead to generic statements that don’t accurately reflect the individual’s desires for end-of-life care.

  2. Forgetting to sign or date the form: In Louisiana, as in many states, a Living Will must be signed and dated to be legally valid. An unsigned or undated form can be easily contested or entirely disregarded in a medical crisis.

  3. Failing to have the form witnessed or notarized: While notarization isn’t strictly necessary in Louisiana, having the Living Will witnessed (by two individuals who are not beneficiaries) can strengthen its validity and ensure that the individual’s wishes are respected.

  4. Not discussing their wishes with family members and healthcare providers: A Living Will can only be effective if the people involved in implementing it know of its existence and understand the person’s wishes. Neglecting to have these critical conversations can lead to confusion and distress.

  5. Not updating the document after major life changes: Life circumstances and medical preferences can change. Failing to update a Living Will after events such as a marriage, divorce, diagnosis, or a change in medical treatment preferences can result in a document that no longer reflects current wishes.

  6. Storing the document in an inaccessible place: A Living Will is of no use if no one can find it when needed. Keeping the document in a secure yet accessible place and letting trusted individuals know where to find it is crucial.

By avoiding these mistakes, you can ensure that your Louisiana Living Will accurately reflects your healthcare preferences and that your wishes will be respected should you become unable to communicate them.

Documents used along the form

When considering the creation of a Louisiana Living Will, a document that helps outline your wishes regarding medical treatment in the event that you cannot communicate them yourself, it's crucial to be aware of other documents that complement this important form. These documents can offer a comprehensive approach to planning for unexpected medical situations, ensuring your health care preferences are known and respected. Below is a brief description of up to five additional forms and documents often used alongside the Louisiana Living Will, each playing a distinct role in holistic health care planning.

  • Durable Power of Attorney for Health Care - This document designates a trusted individual to make health care decisions on your behalf if you become unable to do so. Unlike a Living Will, which guides specific treatments or conditions, a Durable Power of Attorney for Health Care covers a broad range of health care decisions, including those not anticipated by the Living Will.
  • Physician Orders for Life-Sustaining Treatment (POLST) - The POLST form complements a Living Will by converting your treatment preferences into medical orders. It is designed for individuals facing serious health conditions, ensuring that their wishes are observed by health care providers across settings.
  • HIPAA Release Form - This document allows specified individuals or entities to access your medical records. It is crucial for enabling health care agents, family members, or others involved in your care to make informed decisions based on your medical history and current condition.
  • Do Not Resuscitate (DNR) Order - A DNR order is a medical order signed by a physician stating that no attempts should be made to resuscitate a patient in the event of cardiac or respiratory failure. This document is especially significant for those who wish not to receive CPR or other life-sustaining procedures under certain circumstances.
  • Organ and Tissue Donation Registration Form - If you wish to donate your organs or tissues after death, this form records your consent and preferences. It's an important document for ensuring your wishes regarding organ donation are followed.

Understanding and preparing these documents in conjunction with your Louisiana Living Will can significantly impact your health care planning, providing peace of mind for you and your loved ones. Each document serves a unique purpose, ensuring that various aspects of your health care wishes are documented and legally acknowledged. It's advisable for anyone looking to establish a comprehensive health care directive to consider these forms holistically.

Similar forms

  • Power of Attorney for Healthcare: This document, similar to a Living Will, allows an individual to appoint someone else to make healthcare decisions on their behalf if they become unable to make such decisions themselves. The difference lies in its broader scope, encompassing not just end-of-life decisions but any medical decision.

  • Advance Directive: Often used interchangeably with a Living Will, an Advance Directive outlines a person’s wishes regarding medical treatment and care when they are no longer able to communicate those preferences directly. It can include components of both a Living Will and a Power of Attorney for Healthcare.

  • Durable Power of Attorney for Finances: While focusing on financial decisions, this document parallels the Living Will in its approach to planning for future incapacity. It designates an agent to manage financial affairs if the individual is unable to do so, ensuring continuity beyond health care aspects.

  • Do Not Resuscitate (DNR) Order: A DNR is a medical order that prevents healthcare providers from performing CPR if a person’s breathing stops or if the heart stops beating. It’s similar to a Living Will in that it dictates specific medical interventions to be avoided at the end of life.

  • Organ and Tissue Donation Registration: This consent form allows individuals to specify their wishes regarding organ and tissue donation after death. Like a Living Will, it communicates specific directives to be followed—in this case, about the donation of organs and tissues for transplantation or research.

  • Five Wishes Document: Expanding on the concept of a Living Will, the Five Wishes document addresses personal, emotional, and spiritual needs alongside medical wishes. It serves as a holistic approach to end-of-life planning, covering areas often left untouched by more traditional documents.

  • Physician Orders for Life-Sustaining Treatment (POLST): Much like a Living Will, a POLST informs medical personnel of a patient’s preferences regarding life-sustaining treatments. This legally binding document is designed for people with serious illnesses or frailty, emphasizing the importance of adhering to the patient’s wishes.

  • Last Will and Testament: Although primarily focused on the distribution of assets after death, a Last Will shares the anticipatory nature of a Living Will. It prepares for an inevitable future event by outlining the individual’s wishes, ensuring they are respected and followed.

Dos and Don'ts

When you're filling out a Louisiana Living Will form, it’s important to take your time and complete it carefully. This document outlines your wishes regarding medical treatment if you ever become unable to communicate these preferences yourself. Here are some dos and don'ts to consider during the process:

Do:
  • Read the instructions carefully before you begin. Understanding every section can help ensure you fill out the form accurately.
  • Consult a healthcare professional if you have any questions about medical terms or treatments mentioned in the form.
  • Discuss your decisions with close family members or friends. Sharing your wishes can help prevent confusion or conflict later.
  • Consider consulting with an attorney familiar with Louisiana’s laws on living wills to make sure your document reflects your wishes and complies with state regulations.
  • Be specific about your medical treatment preferences. Clear instructions can guide your healthcare providers and loved ones when making decisions on your behalf.
  • Sign and date the form in the presence of two witnesses or a notary public, depending on Louisiana’s requirements at the time of signing.
  • Keep the original document in a safe but accessible place, and inform your healthcare proxy, if you have one, about where it is kept.
  • Provide copies of the completed form to your healthcare proxy, family doctor, and possibly family members.
  • Review and update your living will periodically, especially after significant life changes or changes in your health.
  • Respect your right to change or revoke your living will at any time. Make sure to communicate any changes clearly to all involved parties.
Don't:
  • Rush through the process. Take your time to consider your options and the implications of your choices.
  • Use vague language. Ambiguities can lead to confusion and may result in your wishes not being followed as you intended.
  • Forget to discuss your living will with the person or people you designate to make health care decisions for you.
  • Overlook state-specific requirements. Louisiana may have unique requirements for living wills that differ from other states.
  • Assume your doctors are familiar with your wishes without providing them with a copy of your living will.
  • Leave out contact information for your healthcare proxy and family members who should be notified in an emergency.
  • Sign the document without witnesses or a notary public, as this could make it invalid.
  • Fail to provide copies to relevant parties. Keeping your living will to yourself defeats its purpose.
  • Leave the document in a place where no one can access it. If it can’t be found, it can’t be followed.
  • Ignore changes in your health, personal views, or relationships that might affect your decisions.

Misconceptions

There are several misconceptions about the Louisiana Living Will form that often create confusion among individuals. Understanding these misconceptions can help clarify the nature and use of the Living Will and aid in making informed decisions.

  • It's only for the elderly: A common misconception is that Living Wills are only for older adults. However, any individual over the age of 18 can and should consider preparing a Living Will. It allows you to express your wishes regarding medical treatment in the event that you're unable to communicate those wishes yourself due to a serious health condition.

  • You need a lawyer to create one: While legal advice can be beneficial, especially in complicated situations, Louisiana law does not require a lawyer to draft a Living Will. Resources are available to guide individuals through the process, ensuring their Living Will conforms to state law.

  • It's too expensive: Contrary to belief, creating a Living Will in Louisiana does not have to be an expensive process. Many resources offer templates or assistance at low or no cost. The expense comes in if you choose to involve an attorney for personal guidance.

  • It's the same as a Last Will and Testament: A Living Will is often confused with a Last Will and Testament, but they serve different purposes. A Living Will dictates your wishes regarding medical treatment if you become incapacitated, whereas a Last Will and Testament addresses the distribution of your assets upon death.

  • My family knows what I want: Assuming family members know your wishes for medical treatment can lead to stress and confusion during difficult times. A Living Will clearly outlines your preferences, which can provide guidance and peace of mind for your loved ones.

  • It only covers "Do Not Resuscitate" orders: While a Living Will can specify a desire not to have CPR performed if your heart stops, it can also include a wide range of directives, including your wishes on the use of life support, feeding tubes, and other specific medical treatments under certain conditions.

  • It cannot be changed: Another misconception is that once a Living Will is made, it cannot be altered. In reality, a Living Will can be revised or revoked at any time as long as you are still competent. Changes should be communicated to all relevant parties, including healthcare providers and family members.

  • It guarantees my medical wishes will be honored: Although a Living Will provides clear guidance on your wishes, there are instances where healthcare providers might not follow it exactly, due to emergency situations, conflicting interpretations, or other unforeseen circumstances. It is important to discuss your Living Will with your healthcare provider to ensure clarity.

Key takeaways

The Louisiana Living Will form is an essential document for anyone who wants to ensure their healthcare wishes are known and respected in case they're unable to communicate them. Here are eight key takeaways about filling out and using this form:

  • Understand the Purpose: It allows you to document your preferences regarding medical treatment in situations where you are unable to make decisions for yourself.
  • Legal Requirements: For the form to be valid, it must be signed in the presence of two witnesses and notarized in Louisiana. Ensure that all parties fully understand the document's implications before signing.
  • Choose an Agent Carefully: If you decide to appoint a healthcare proxy or agent, choose someone you trust to make healthcare decisions for you, and discuss your values and wishes with them thoroughly.
  • Be Specific: The more detailed your instructions are, the better your healthcare providers will understand your preferences. Consider all types of life-sustaining treatments, like artificial ventilation or feeding tubes, and state your wishes about each.
  • Discuss With Your Doctor: It's helpful to talk about your living will with your healthcare provider to ensure your wishes are medically sound and can be followed in the hospital setting.
  • Keep It Accessible: After completing the form, make sure a copy is easily accessible. Give copies to your healthcare agent (if you have one), your doctor, and any family members or friends who might be involved in your care.
  • Review Periodically: As your health condition and preferences change, it's important to review and possibly update your living will. Life events such as marriage, divorce, the birth of a child, or a significant change in health status should prompt a review of your living will.
  • Respect for Choices: Remember, creating a living will is about your right to make decisions about your own health care. It ensures your wishes are respected and provides guidance for your loved ones during difficult times.
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