Living Will (Canada)

This Living Will is a legal document that allows an individual to decide on future healthcare decisions in the event they are unable to make them on their own. It sets forth any specific wishes you have regarding basic healthcare and measures to keep you free of pain. Every individual should have a Living Will.

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A Living Will is a legal document that allows an individual to decide on future healthcare decisions in the event they are not able to make them on their own at that time. If you are injured in an accident or suffer an unforeseen illness, having a Living Will communicates to your physician, hospital and family your wishes for the types and extent of the medical measures used to keep you alive. This Living Will sets forth your specific wishes regarding your health including a request for basic healthcare and measures to keep you free of pain. It also sets out any specific instructions regarding treatments and who to consult if there are uncertainties about your wishes. It is imperative that everyone have a written Living Will.

This Living Will contains the following provisions:
  • Personal Information: Sets out the signor’s full name and address, date of birth and physician’s name, address and telephone number;
  • Specific Treatments: A detailed list of any specific treatments or investigations you wish regarding your health;
  • Personal Wishes: Any personal wishes or statements you desire to make regarding your healthcare;
  • Consultant: The name, address and phone number of who should be consulted if there are questions regarding your personal wishes regarding your healthcare;
  • Signatures: This document must be signed in the presence of two witnesses.

Protect yourself and your rights by purchasing this accurate and up-to-date form.

This lawyer-prepared package includes:
  1. General Instructions
  2. Living Will for Canada
Law Compliance: This form can be used in the following provinces: Alberta, British Columbia, Manitoba, New Brunswick, Newfoundland and Labrador, Northwest Territories, Nova Scotia, Nunavut, Ontario, Prince Edward Island, Saskatchewan and Yukon
This is the content of the form and is provided for your convenience. It is not necessarily what the actual form looks like and does not include the information, instructions and other materials that come with the form you would purchase. An actual sample can also be viewed by clicking on the "Sample Form" near the top left of this page.
 
 
Living Will
 
 
Full Name:        
Full Address:        
Date of Birth:        
Doctors Name:        
Doctors Address:        
Doctors Telephone No:        
 
I have made this declaration at a time when I am of sound mind and after careful consideration. I understand that my life may be shortened by the refusals of treatment in this form. I accept the risk that I may not be able to change my mind in the future when I am no longer able to speak for myself, and I accept the risk that improving medical technology may offer increased hope, but I personally consider the risk of unwanted treatment to be a greater risk. I want it to be known that I fear degradation and indignity far more than death. I ask my medical attendants to bear this in mind when considering what my intentions would be in any uncertain situation.
 
If the time comes when I can no longer communicate, this declaration shall be taken as a testament to my wishes regarding medical care. If it is the opinion of two independent doctors that there is no reasonable prospect of my recovery from severe physical illness, or from impairment expected to cause me severe distress or render me incapable of rational existence, then I direct that I be allowed to die and not be kept alive by artificial means such as life support systems, tube feeding, antibiotics, resuscitation or blood transfusions: any treatment which has no benefit other than a mere prolongation of my existence should be withheld or withdrawn, even if it means my life is shortened.
 
I accept basic care however and I request aggressive palliative care, drugs or any other measures to keep me free of pain or distress, even if they shorten my life.
 
I have the following wishes about specific treatments or investigations:
 
     
 
My other wishes/personal statement:
 
     
 
I wish the following person to be consulted in the event of uncertainty about my wishes:
 
Name:        
Address:        
 
Telephone No:        
IN WITNESS WHEREOF the donor has set his or her hand and seal on      .
 
 
 
 
 
 
SIGNED, SEALED AND DELIVERED
in the presence of:
 
 
   
     
     
 
 
   
     
     
 
 
 
 
 
 
 
 
   
      
 
 
Number of Pages4
DimensionsDesigned for Letter Size (8.5" x 11")
EditableYes (.doc, .wpd and .rtf)
UsageUnlimited number of prints
Product number#28860

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