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Rhode Island Living Will Form

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Rhode Island Living Will Form

Updated August 03, 2023

A Rhode Island living will declaration makes it known whether a patient would like to request or withhold life-saving procedures. This is made only for cases when there is no curable solution to a person’s condition and allows them to die a natural death. This is a recommended form for the elderly and those with pre-existing conditions.


How to Write

Download: PDF

Step 1 – Identify The Rhode Island Patient Behind This Declaration

The introduction to this document will cite the “Rhode Island General Laws” as the governing law for this declaration. It is strongly recommended that you review this paragraph before proceeding.  This template shall apply some necessary language so that the Patient issuing it as a directive can effectively communicate with Rhode Island Health Care Personnel (if incapacitated). Naturally, the wording in this document will only function correctly if the Patient’s name supplements the information of the first paragraph under the “Declaration” title. Locate the space between the word “I” and the phrase “Being Of Sound Mind Willfully…” This space should be supplied with the full name of the Patient, otherwise known as the Declarant, issuing this paperwork as a notice to Rhode Island Health Care Personnel responsible for his or her medical treatment or intervention. The Declarant will wish to make a statement regarding his or her care if suffering from “…An Incurable Or Irreversible Condition” while also being unable to communicate effectively. The second paragraph in the “Declaration” section shall state in no uncertain terms that any medical intervention designed to prolong the process of dying should be withheld since it is being formally refused by the Patient through this statement’s language. 


Step 2 – Authorize The Appropriate Level Of Care Desired By The Patient

The Patient behind this declaration can also choose to withhold, cease, or refuse any artificial feeding when suffering a terminal condition by marking the check box labeled “Includes” after the term “This Authorization…” (see example below). This checkbox statement, when selected, will be attached to the directive made by the second paragraph. However, if this statement should not be applied to the declaration above, leave the corresponding checkbox blank so that you can review the next option. One of these statements must be marked but since they contradict one another only one may be selected and applied with the language above.  If the Patient wishes to receive nutrients artificially even after the dying process has begun, then the second checkbox statement (labeled “Does Not Include”) should be selected. This statement will be attached to the above “Declaration” as a formal request that nutrients and hydration are provided to the Patient up to the point of death as needed (see below). Only one of these statements can be selected as clarification on the issue of nutrients.   


Step 3 – Set The Rhode Island Patient’s Declaration Date

The validity of this paperwork as a true and up-to-date representation of the Patient’s wishes can be demonstrated through the next few requested. The first of these will be the calendar date that marks the day when the Rhode Island Patient signs this paperwork to effect. This date should be distributed across three spaces after the words “Signed This…” Notice this information is requested as a two-digit calendar day, the name of the appropriate month, then the two-digit calendar year.   


Step 4 – Present The Effective Signature Of The Patient

The “Signature” line underneath the signature date statement must be signed by the Patient issuing this document on the concerned day. This act should be performed before two Witnesses. Clear identification of the Issuing Patient should be included with the signature he or she provided. To this end, the “Address” line has been set for a record of the Rhode Island Declarant’s or Patient’s full residential address to be presented. Once the Patient has completed furnishing this material, he or she must then hand the document to one of the Witnesses.


Step 5 – Acquire A Presentation Of The Witness Testimony

After the Rhode Island Witnesses have observed the Patient (or Declarant) signing the completed directive, each must read the testimony attesting to this action. To show agreement with this statement and validation that the Patient’s signature is authentic, the first Witness must sign the “Witness Signature” line directly under the statement “The Declarant Is Personally Known…” then announce the date of signature by recording it after the word “Date.”  Once this signature and accompanying date is provided, the First Witness must tend to the “Address” line below his or her signature with his or her own residential address.  The Second Witness will have his or her own area to perform the same actions. He or she will need to read the Witness testimonial then locate the available “Witness Signature” line. The Second Witness must sign his or her name on this line then attach the official signature date using the adjacent area.  The final requirement of the Second Witness will be to furnish a record of his or her residential address on the final blank line. Upon completing this requirement, the Patient (or Declarant) should take control of this document, make the needed amount of copies, so that he or she can keep the original, and dispense copies to any concerned Medical  Institutions.