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Wisconsin Living Will Form (Declaration to Physicians)

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The Wisconsin living will, or ‘Declaration to Physicians, is a legal document that is prepared in writing by the Declarant/Principal that would state their personal preferences with regard to how they would like their physician and/or medical team, to attend to the declarant’s wishes in an end of life scenario. This form may be revoked at any time. If the declarant is unsure about how to complete the document, they may choose to schedule a consultation with a qualified attorney for assistance.

Definition – § 154.02(1)

Laws – Chapter 154 (Advance Directives)

Medical Power of Attorney – Create a relationship where another person is able to take care of your health care responsibilities in the chance you are not able to due to a coma, surgery, or to being incapacitated.

How to Write

Step 1 -Download the document and very carefully review the document. Be certain, as the declarant, that you understand the document prior to completion and signature.

Step 2 – Declaration to Physicians/Establishment of Declarant/Principal (Wisconsin Living Will) –

  • Declarant must enter their full legal name into the first line of the document
  • Read the remainder of the paragraph to ensure you understand what you are preparing

Step 3 – Medical/Terminal Conditions – Any condition that is considered life ending, must be verified by two physicians –

  • The Declarant must read the brief statement
  • Initial the box that best serves your decision

Step 4 – Persistent Vegetative State and Life Sustaining Procedures –

  • Declarant must read the statement and selections
  • Declarant must make their selection by initialing their selection

Step 5 – Persistent Vegetative State and Use of Feeding Tubes –

  • The Declarant must read the brief statement
  • Initial the box that best serves your decision

Step 6 – Declarant and Witness Signatures – All signatories must enter their signatures all present at the same time. All must enter the following information:

Declarant/Principal –

  • Signature of Declarant
  • Date of Signature in mm/dd/yyyy format
  • Physical Address
  • Date of Birth

Step 7 – Witnesses must read the brief statement. If in agreement, enter the following:

Witness 1 – 

  • Witness Signature
  • Date Signed
  • Print Name

Witness 2 – 

  • Witness Signature
  • Date Signed
  • Print Name

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