Tennessee Living Will Template
This Living Will is designed in accordance with the Tennessee Right to Natural Death Act, providing a way for individuals to declare their wishes concerning medical treatment in the event they are unable to communicate their decisions due to illness or incapacity.
Complete the following sections with your information to outline your healthcare preferences.
Personal Information
Name: ___________________________
Date of Birth: ___________________
Address: _________________________
City: ____________________________
State: Tennessee
Zip Code: _______________________
Healthcare Directives
This section outlines your preferences for medical treatment and interventions.
Life-Prolonging Treatments
In the situation where I am unable to communicate and am diagnosed with a terminal condition or am in a persistent vegetative state, my wishes regarding life-prolonging treatments are as follows:
- _____ I wish to receive all available life-prolonging treatments, including artificial nutrition and hydration.
- _____ I wish to receive life-prolonging treatments, except in cases where the treatment would only prolong the process of dying or would not be expected to restore consciousness.
- _____ I do not wish to receive any life-prolonging treatments, including artificial nutrition and hydration, if these treatments would only serve to artificially prolong the dying process.
Additional Healthcare Directives
If there are other specific treatments or healthcare preferences, not mentioned above, that I wish to accept or refuse, they are documented here:
__________________________________________________________________________
__________________________________________________________________________
Designation of Healthcare Proxy
In the event that I cannot make healthcare decisions for myself, I designate the following individual as my healthcare proxy, who is authorized to make medical decisions on my behalf:
Name: ___________________________
Relationship to Me: ______________
Primary Phone Number: ___________
Alternate Phone Number: _________
Signatures
This Living Will becomes effective only when I am unable to communicate my healthcare preferences directly. By signing below, I affirm that this document reflects my desires and that I have executed it voluntarily.
Signature: ___________________________
Date: _______________________________
Witness Signature: _______________________
Witness Name: ___________________________
Date: __________________________________
This document should be shared with your healthcare proxy, family, and healthcare providers to ensure your wishes are known and can be followed.