Washington D.C. Living Will (Declaration) Form

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Updated June 02, 2022

A Washington D.C. living will is a declaration stating a person’s treatment options at the end of their life. Such treatment options include withholding artificial breathing, nutrition, hydration, and whether to donate organs. The form is required to be signed with two (2) witnesses and a copy should always stay with the principal at all times. If this living will is made with medical power of attorney then a copy should also be placed with the agent.

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(1) Declaration Date. The calendar date when this document will be considered an active instruction from the D.C. Patient issuing it must be established in the first statement.

(2) Washington D.C. Declarant. Washington D.C. enables Patients to decide upon life-sustaining treatment if that Patient has been diagnosed with an untreatable and life-threatening medical condition. The nature of this decision requires specific language and clear identification of the Patient issuing it therefore, produce the full name of the Washington D.C. Patient who has determined his or her stance on life-prolonging treatment and wishes to declare it in this document. For our purpose, it will be assumed that you are both the Preparer of this paperwork as well as the Washington D.C. Patient or Declarant issuing it.

(3) Life-Sustaining Treatment Refusal. In order to inform Washington D.C. Medical Professionals that you do not wish to receive any life-prolonging treatment or medications (outside of maintaining your comfort level), initial the first declaration.

(4) Requesting Life-Sustaining Treatment. You can use this paperwork to request that life-sustaining treatment be administered to keep you alive after D.C. Medical Professionals have diagnosed you with an untreatable and life-treating medical condition by initialing the second directive.

(5) D.C. Declarant Executing Signature. The Washington D.C. Patient making this directive will be expected to sign it before two Witnesses who are adults. Once these Parties have gathered, you, as the Washington D.C. Patient or Declarant must sign your name to the “Declarant’s Signature” line.

(6) Signature Date Of D.C. Declarant. Once you have signed your name, produce a record of the current date. This will inform the Washington D.C. Medical Professionals reviewing your directive of how recent it is.

(7) Address Of D.C. Declarant. Submit your residential address with your signature.

(8) Witness Signature Statement. Both Witnesses must sign their names to the signature statement made to prove its accuracy.

(9) Witness Signature Date. Each Witness’s signature date is required and will be expected to be the same as yours.