Living Will Sample Connecticut
(aka "Advanced Medical Directive")
Online Living Will Form $8.99 (free trial)−−click here
ADVANCE MEDICAL DIRECTIVE AND
POWER OF ATTORNEY FOR HEALTH CARE
JAMES ROBERT HEDGES
THIS IS AN IMPORTANT LEGAL DOCUMENT. THIS DOCUMENT DIRECTS THE MEDICAL
TREATMENT YOU ARE TO RECEIVE IN THE EVENT YOU ARE UNABLE TO PARTICIPATE
IN YOUR OWN MEDICAL DECISIONS AND YOU ARE EITHER IN A TERMINALLY ILL
CONDITION OR PERSISTENTLY UNCONSCIOUS. THIS DOCUMENT CAN CONTROL
WHETHER YOU LIVE OR DIE. PREPARE THIS DOCUMENT CAREFULLY AND READ IT
COMPLETELY. PLEASE REVIEW IT PERIODICALLY.
You have the right to give instructions about your own health care. You also have the right to name
someone else to make health−care decisions for you. This form lets you do either or both of these things.
It also lets you express your wishes regarding donation of organs and the designation of your primary
physician. If you use this form, you may complete or modify all or any part of it. You are free to use a
Part 1 of this form is a power of attorney for health care. Part 1 lets you name another individual as agent
to make health−care decisions for you if you become incapable of making your own decisions or if you
want someone else to make those decisions for you now even though you are still capable. You may also
name an alternate agent to act for you if your first choice is not willing, able, or reasonably available to
make decisions for you. Your agent may not be an owner, operator, or employee of a residential
long−term health−care institution at which you are receiving care.
Under this agreement, your agent must follow the directions you give in Part 2 hereof regarding which
types of health care treatment are to withdrawn or withheld under the circumstances stated.
Part 2 of this form lets you give specific instructions about any aspect of your health care. Choices are
provided for you to express your wishes regarding the provision, withholding, or withdrawal of treatment
to keep you a