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West Virginia Living Will Form

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The West Virginia living will is a legal document, written by a Declarant/Principal that shall explain whether or not the Declarant would choose to be on life support if they were to  fall terminally ill and likely die without life support, or in the event they should fall into a coma or persistent vegetative state. A living will, is going to state that they either want or will not want, artificial life support if either the Declarant should become terminally ill and would be likely to succumb to death in a short time without the aid of life support of any kind or in the event the Declarant may fall into a coma or vegetative state.

Definition – § 16-30-3(n)

Laws – § 16-30-4

Medical Power of Attorney – Give access to making health care decisions on your behalf if there is ever the unfortunate event that you cannot make them for yourself.

How to Write

Step 1 – Preparation of Directive –

  • Date the execution of the document in dd/mm/yyyy format
  • Enter the full legal name of the declarant/principal

Step 2 – Declarant continuation of document completion – The declarant must continue to complete the next two paragraphs in order to properly educate themselves with regard to what they are preparing

Step 3 – Section C – Once the Declarant reaches section C, they must read the brief statement and respond with an “I want” or “I do not want” response by initialing the box preceding the selection.

  • The Declarant must then continue to carefully review the remainder of the document
  • Once the Declarant reaches section “G” they may write or type any additional instructions they wish to include
  • Declarant must then enter their signature in the “Signed” line

Step 4 – Witness Signatures – The witnesses must carefully read the statement of eligibility. Each witness would then enter their signature

Witness 1 – 

  • Witness Signature

Witness 2 – 

  • Witness Signature