Updated August 03, 2023
An Ohio living will is a declaration stating a person’s preference to receive life-sustaining treatments or die a natural death. This would only come into effect if the declarant is in a terminal and incurable condition where the only recourse is pro-longing an unavoidable death. A living will is commonly completing with a medical power of attorney that allows a person to select an agent to make health care decisions on their behalf.
Laws
- Signing Requirements – Two (2) witnesses or a notary public (Section 2133.02(B)).
- Statutes – Chapter 2133 (Modified Uniform Rights of the Terminally Ill Act)
How to Write
Download: PDF
Step 1 – Download the document. The Declarant/Principal must carefully read the section located on the first page of the document, so that they may be better informed regarding what to expect by completing this document.
Step 2 – Establishment of Declarant – Enter the following at the top of the second page of the document:
- Print the Declarant’s Full Legal Name
- Enter the Declarant’s Dte of Birth in mm/dd/yyyy format
- The Declarant should take the time to review the definitions that will be found throughout the document. You may refer back to them at any time if you need to be clear.
- If at any point this document becomes overwhelming or you do not understand, consider a consultation with an attorney.
- At the end of the definitions, you will be asked if you have completed a power of attorney before, simply check yes or no in the box provided on teh form
Step 3 – Before the Declarant continues with the completion of the form, read the notification. [R.C. §2133.05(2)(a)]
Step 4 – Contact Information – If the Declarant should decide against use of this section, simply place an “X” through this section. If the Declarant wishes to provide this information, complete this area as follows:
- First contact’s name and relationship
- Address
- Telephone number(s)
- AND
- Second contact’s name and relationship
- Address
- Telephone number(s)
- AND
- Third contact’s name and relationship
- Address:
- Telephone number(s)
Step 4 – Declarant’s Authorization to Physician- For the purpose of providing comfort care, I authorize my physician to:
- For the purpose of providing comfort care, I authorize my physician to:
- Administer no life-‐sustaining treatment, including CPR
- Withhold or withdraw artificially or technologically supplied nutrition or hydration, provided that, if I am in a permanently unconscious state, I have authorized such withholding or withdrawal under Special Instructions below and the other conditions have been met
- Issue a DNR Order
- Take no action to postpone my death, providing me with only the care necessary to make me comfortable and to relieve pain.
Step 5 – Special Instructions – If the Declarant has special instructions they would like to interject as stated, initial the box provided
Step 6 – Additional instructions or limitations – Enter any additional instructions into the box provided. If more space is required, continue on a separate sheet and attach it to the document
Step 7 – Anatomical Gift (optional) – The “anatomical gift” language provided is required by ORC §2133.07(C)
- Should the Declarant wish to provide anatomical gifts, check the boxes in this section that you would like to donate
- Specify how you would like your gifts to be used
- Notify all family members, physicians etc. Read the statement, if in agreement provide the following:
- Date the Declarant’s Signature in mm/dd/yyyy format
- Enter location in which the declaration is being signed
- Enter the Declarant’s Signature
Step 8 – The Declarant may choose whether they would prefer two witnesses OR a notary public as witness:
- Should the Declarant choose witnesses, it’s vital that they understand what is unacceptable as a witness for your protection:
- WITNESSES [R.C. §2133.02(B)(1)]
- [The following persons CANNOT serve as a witness to this Living Will Declaration
- Your agent in your Health Care Power of Attorney, if any
- The guardian of your person or estate, if any
- Any alternate agent or guardian, if any
- Anyone related to you by blood, marriage or adoption (for example, your spouse and children)
- Your attending physician
- The administrator of the nursing home where you are receiving care
Step 9 – Should you decide to use two witnesses, they must enter the following information:
Witness 1-
- Witness One’s Signature
- Witness One’s Printed Name
- Date in mm/dd/yyyy format
- Witness One’s Address
Witness 2 –
- Witness Two’s Signature
- Witness Two’s Printed Name
- Date in mm/dd/yyyy format
- Witness Two’s Address
If the Declarant prefers a Notary Public as witness, the notary will complete the remainder of the document and acknowledge with their state seal.
Step 10 – State of Ohio Donor Registry Enrollment Form Notice to Declarant – If the Declarant would like to be an organ donor you must read the following and then complete the form.
Step 11 – Additional Information Included in this Packet
- Ohio’s Do Not Resuscitate Laws
- The Hospice Choice