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Rhode Island Living Will Declaration Form

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The Rhode Island Living Will, or ‘Declaration’, is a document that the state of Rhode Island has prepared for those who would like to have a document in place, regardless of the fact that the state only suggests some form of living will to be kept in their medical records but does not require it’s use. This document may be revoked at any time. If at any time the Declarant would prefer to prepare a more in depth document, a consultation with a qualified attorney is highly recommended in this case.

Definition – § 23-4.11-2(4)

Laws – Chapter 23-4.11 (Rights of the Terminally Ill Act)

Medical Power of Attorney – Allows a patient to select a spokesperson to make all decisions on their behalf in the unfortunate event they cannot make them.

How to Write

Step 1 – Establishment of the Declarant –

  • Beginning on page two(2) of the document enter the full legal name of the Declarant/Principal
  • Declarant/Principal must read the remaining 2 paragraphs to be certain that they understand the document they are preparing

Step 2 – Inclusion or Exclusion of Artificial Feeding-

  • The Declarant/Principal may simply decide if they do or do not choose to be artificially fed in an end of life scenario by checking the appropriate box
  • Date the Declarant’s Signature in dd/mm/yyyy format
  • Enter the Signature of the Declarant
  • Enter the Declarant’s address

Step 3 – Witnesses – Read the brief statement – if in agreement enter the following:

Witness 1 –

  • Signature of Witness
  • Address of Witness

Witness 2 – 

  • Signature of Witness
  • Address of Witness

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