Tennessee Living Will Template
This document serves as a Living Will, also known as an "Advance Directive for Health Care," in accordance with the Tennessee Right to Natural Death Act. It articulates the preferences of the undersigned individual regarding medical treatment in situations where they are no longer able to communicate their wishes directly.
Section 1: Personal Information
Full Name: ________________________________________
Date of Birth: _____________________________________
Address: __________________________________________
City: __________________ State: TN Zip: ______________
Telephone Number: _________________________________
Section 2: Declaration
I, _____________________, being of sound mind, willfully and voluntarily make known my desire that my dying shall not be artificially prolonged under the circumstances set forth below. This declaration reflects my firm and settled commitment to decline medical treatment that only serves to postpone the moment of my death.
Section 3: Directions for Health Care
I do not desire any medical treatment that would only serve to prolong the dying process. This includes, but is not limited to, mechanical ventilation, artificial nutrition and hydration, and cardiopulmonary resuscitation (CPR).
In the event that I am unable to communicate my preferences myself, I appoint the following individual as my health care agent:
Agent's Full Name: ________________________________________
Relationship to Me: ________________________________________
Agent's Telephone Number: __________________________________
If my condition is terminal and I am unable to communicate, I desire that all treatments other than those needed for my comfort be discontinued or withheld.
I desire that my doctors heed the instructions of my health care agent, assuming that my agent's decisions adhere to what I would have chosen if I were able to do so.
Section 4: Organ Donation
I do / do not (circle one) wish to donate any organs or tissues at the time of my death for purposes of transplant, research, or education.
Section 5: Signature
This document is intended to be a legally binding document that will be respected and followed by my family, doctors, and hospitals. By signing below, I affirm that I am fully informed of the contents of this directive and understand its purpose and effect.
___________________________ __________________
Signature Date
Section 6: Witness Declaration
This Living Will must be signed in the presence of two witnesses who are not related to me by blood or marriage, and who would not be entitled to any part of my estate.
Witness 1 Signature: _________________________ Date: _________________
Witness 1 Printed Name: ________________________
Witness 2 Signature: _________________________ Date: _________________
Witness 2 Printed Name: ________________________
Section 7: Notarization (Optional)
Though not required by Tennessee law, notarization of this living will can provide an additional layer of legal protection.
Notary Public Signature: _________________________ Date: _________________
Notary Public Printed Name: ________________________
My commission expires: ____________________________
Creating a Living Will is a responsible step to ensure that your health care preferences are respected. It is recommended that you consult with a legal professional to understand the full implications of this document.