Contents
In North Carolina, the Living Will form serves as a crucial document for individuals wishing to express their healthcare preferences in the event they become unable to communicate their wishes. This legal instrument outlines a person's desires regarding life-sustaining treatments, such as resuscitation efforts and artificial nutrition, ensuring that their choices are honored even when they cannot speak for themselves. By completing this form, individuals can designate their preferences for medical interventions, providing clarity and guidance to healthcare providers and loved ones during difficult times. The form typically requires the signature of the individual and witnesses to validate its authenticity, making it essential to follow the state's specific requirements. Understanding the nuances of this document empowers individuals to take control of their healthcare decisions, fostering peace of mind for both themselves and their families.
Sample - North Carolina Living Will Form
North Carolina Living Will
This living will is designed in accordance with the North Carolina Advance Directive for a Natural Death Act. It serves as a legal document that outlines your preferences for medical treatment in the event that you are unable to communicate these decisions yourself.
Personal Information
Full Name: ___________________________
Date of Birth: ___________________________
Address: ___________________________
City: ___________________________
State: North Carolina
Zip Code: ___________________________
Telephone Number: ___________________________
Living Will Declarations
As the declarant, I direct that my life not be prolonged by life-sustaining measures, if I:
- Suffer from a terminal condition where the application of life-sustaining measures would only serve to artificially prolong the dying process and where my attending physician determines that my death is imminent, regardless of the provision of life-sustaining measures.
- Become unconscious and, to a high degree of medical certainty, will remain unconscious for the remainder of my life without the possibility of recovery.
- Suffer from a condition where the burdens of treatment outweigh the expected benefits, and I am unable to participate in these treatment decisions.
This declaration instructs my physician and healthcare providers to withhold or withdraw life-sustaining measures that serve only to prolong the process of dying under the conditions specified above.
Special Provisions and Limitations
(Optional) In this section, you may specify any particular life-sustaining measures you would want to be withheld or provided, under certain conditions. These can include instructions regarding artificial hydration and nutrition, mechanical ventilation, and other treatments.
________________________________________________________________
________________________________________________________________
Designation of Health Care Agent
I hereby designate the following individual as my healthcare agent, who is authorized to make healthcare decisions on my behalf, should I become incapable of making my own decisions:
Name: ___________________________
Relationship: ___________________________
Address: ___________________________
City: ___________________________
State: North Carolina
Zip Code: ___________________________
Telephone Number: ___________________________
Signature
This document is legally binding and reflects my desires regarding life-sustaining treatment. I sign this document willingly and without any undue influence, on the ____ day of _______________, 20____.
____________________________________
(Your Signature)
Date: ___________________________
Witness Declaration
Two witnesses must sign this document, attesting that the declarant is known to them, signed this document in their presence, and appears to be of sound mind and not under duress, fraud, or undue influence.
Name of Witness 1: ___________________________
Signature of Witness 1: ___________________________
Date: ___________________________
Name of Witness 2: ___________________________
Signature of Witness 2: ___________________________
Date: ___________________________
File Specs
| Fact Name | Details |
|---|---|
| Purpose | A Living Will allows individuals to outline their preferences for medical treatment in case they become unable to communicate their wishes. |
| Governing Law | The North Carolina Living Will is governed by N.C. Gen. Stat. § 90-321 through § 90-330. |
| Eligibility | Any adult who is at least 18 years old can create a Living Will in North Carolina. |
| Witness Requirement | The form must be signed in the presence of two witnesses who are not related to the individual or beneficiaries. |
| Revocation | An individual can revoke their Living Will at any time, as long as they are competent to do so. |
| Durable Power of Attorney | A Living Will can be used alongside a Durable Power of Attorney for Health Care, but they serve different purposes. |
| Storage | It is advisable to keep the Living Will in a safe place and provide copies to family members and healthcare providers. |
Some Other North Carolina Templates
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How to Make an Operating Agreement - It includes clauses on how to handle changes to the agreement itself, ensuring the document remains relevant and up-to-date.