Download New York Living Will Form

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New York Living Will Form


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A New York living will allows for a person to make predetermined medical choices for themselves in the chance that they should become incapacitated or in a vegetative mental state. It differs from the health proxy which allows for a person to make medical decisions in your best interests. If the patient decides not to have the form signed with a notary public present the Witness Affidavit should be attached.

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The pre-determined decisions that can be made by the person include;

  • Do Not Resuscitate (DNR) orders not to be administered such as Cardiopulmonary Resuscitation (CPR)
  • Mechanical Respiration
  • Artificial Nutrition
  • Antibiotics
  • Dialysis Cleaning Blood by Machine
  • Blood Transfusions
  • Invasive Diagnostic Tests
  • Anti-Psychotic Medication
  • Electric Shock Therapy
  • Transplantation
  • Abortion/Sterilization
  • Pacemaker Assistance
  • Standard Surgery
  • Pain Relief

The patient may also have the option to donate their organs.

Download (PDF, 25KB)

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