Document end-of-life preferences in Utah: Utah Living Will
What is a Utah Living Will?
A Utah Living Will is a legal document that lays out your preferences regarding health care, such as your refusal or acceptance of a medical treatment, in addition to the optional selection of a chosen agent or decision maker.
The individual making a Living Will is called the "principal," while the person or organization obtaining authority to carry out the principal's wishes is called the "agent." Suited for residents of Utah, this free Living Will can be used in Davis County, Salt Lake County, Utah County, and in all other counties and municipalities across the state. Each Utah Living Will form from Rocket Lawyer can be customized to address your particular circumstances. Making this official document will provide a record of your decisions to healthcare institutions, and it will confirm that your agents have the authority to make choices for you when you are not able.
When to use an Utah Living Will:
- You want to specify your wishes so that it is more likely they will be carried out.
- You are facing the possibility of surgery or a hospitalization.
- You have declining health.
- You have been diagnosed with a terminal condition.
How do I get my Utah Living Will reviewed?
If you already have an Utah Living Will and want to have it reviewed, or if you have questions about creating or using one, there are a few ways to get help.
Use Rocket Copilot to ask questions or review your document; this helps you better understand what it says and identify anything that may need a closer look.
If you are looking for help from a Legal Pro, you can also ask a question and receive a response within one business day, or request a more in-depth document review.
Sample Utah Living Will
The terms in your document will update based on the information you provide
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Consult a Legal Pro to ask questions or review your document
Complies with relevant laws
Utah Advance Health Care Directive
(Pursuant to Utah Code Section 75-2a-117)
Part I: Allows you to name another person to make health care decisions for you when you cannot make decisions or speak for yourself.
Part II: Allows you to record your wishes about health care in writing.
Part III: Tells you how to revoke or change this directive.
Part IV: Makes your directive legal.
My Personal Information
Name:
Street Address:
City, State, Zip Code: ,
| Telephone: |
Cell Phone:
Birth date:
Part I: My Agent (Health Care Power of Attorney)
. No Agent
If you do not want to name an agent: initial the line below, then go to Part II; do not name an agent in B or C below. No one can force you to name an agent.
. My Agent
| Agent Name: |
| Address: |
| , |
| Phone: | Home: Work: |
| Relation, if any: |
| ____ | YES | __X__ | NO | Get copies of my medical records at any time, even when I can speak for myself. |
| __X__ | YES | ____ | NO | Get copies of my medical records at any time, even when I can speak for myself. |
| _________________ |
| (Initial) |
| ____ | YES | __X__ | NO | Admit me to a licensed health care facility, such as a hospital, nursing home, assisted living, or other facility for long-term |
| __X__ | YES | ____ | NO | Admit me to a licensed health care facility, such as a hospital, nursing home, assisted living, or other facility for long-term placement other than convalescent or recuperative care. |
| _________________ |
| (Initial) |
I wish to limit or expand the powers of my health care agent as follows:
I do not wish to include additional limits or expansions of my health care agent.
| ____ | YES | __X__ | NO |
| __X__ | YES | ____ | NO | _________________ |
| (Initial) |
| ____ | YES | __X__ | NO | I authorize my agent to consent to my participation in medical research or clinical trials, even if I may not benefit from the results. |
| __X__ | YES | ____ | NO | I authorize my agent to consent to my participation in medical research or clinical trials, even if I may not benefit from the results. |
| _________________ |
| (Initial) |
| ____ | YES | __X__ | NO | If I have not otherwise agreed to organ donation, my agent may consent to the donation of my organs for the purpose of organ transplantation. |
| __X__ | YES | ____ | NO | If I have not otherwise agreed to organ donation, my agent may consent to the donation of my organs for the purpose of organ transplantation. |
| _________________ |
| (Initial) |
Part II: My Health Care Wishes (Living Will)
I want my health care providers to follow the instructions I give them when I am being treated, even if my instructions conflict with these or other advance directives. My health care providers should always provide health care to keep me as comfortable and functional as possible.
I choose to let my agent decide. I have chosen my agent carefully. I have talked with my agent about my health care wishes. I trust my agent to make the health care decisions for me that I would make under the circumstances.
| _______ | (Initial) |
| Additional Comments: |
I choose to prolong life. Regardless of my condition or prognosis, I want my health care team to try to prolong my life as long as possible within the limits of generally accepted health care standards.
| _______ | (Initial) |
| Other: |
I choose not to receive care for the purpose of prolonging life, including food and fluids by tube, antibiotics, CPR, or dialysis being used to prolong my life. I always want comfort care and routine medical care that will keep me as comfortable and functional as possible, even if that care may prolong my life.
| _______ | (Initial) |
You must also choose either (a) or (b), below.
| _______ | (Initial) (a) I put no limit on the ability of my health care provider or agent to withhold or withdraw life-sustaining care. |
If you selected (a), above, do not choose any options under (b).
| _______ | (Initial) (b) My health care provider should withhold or withdraw life-sustaining care if at least one of the following initialed conditions is met: |
| _______ | (Initial) | I have a progressive illness that will cause death. |
| _______ | (Initial) | I am close to death and am unlikely to recover. |
| _______ | (Initial) | I cannot communicate and it is unlikely that my condition will improve. |
| _______ | (Initial) | I do not recognize my friends or family and it is unlikely that my condition will improve. |
| _______ | (Initial) | I am in a persistent vegetative state. |
| Other: |
However, if at any point it is determined that it is not possible that the fetus could develop to the point of live birth with continued application of life-sustaining treatment, it is my preference that this document be given effect at that point. If life-sustaining treatment will be physically harmful or unreasonably painful to me in a manner that cannot be alleviated by medication, I request that my desire for personal physical comfort be given consideration in determining whether this document shall be effective if I am pregnant.
If you do not want emergency medical service providers to provide CPR or other life sustaining measures, you must work with a physician or APRN to complete an order that reflects your wishes on a form approved by the Utah Department of Health.
Part III: Revoking or Changing a Directive
| I may revoke or change this directive by: |
| 1. Writing "void" across the form, or burning, tearing, or otherwise destroying or defacing this document or directing another person to do the same on my behalf; |
| 2. Signing a written revocation of the directive, or directing another person to sign a revocation on my behalf; |
| 3. Stating that I wish to revoke the directive in the presence of a witness who: is 18 years of age or older; will not be appointed as my agent in a substitute directive; will not become a default surrogate if the directive is revoked; and signs and dates a written document confirming my statement; or |
| 4. Signing a new directive. (If you sign more than one Advance Health Care Directive, the most recent one applies.) |
Part IV: Making My Directive Legal
| I sign this directive voluntarily. I understand the choices I have made and declare that I am emotionally and mentally competent to make this directive. |
My signature on this form revokes any living will or power of attorney form, naming a health care agent, that I have completed in the past.
Date:____________________
| Signature: | ________________________________________ |
| Name: |
| Address: |
| County |
| I have witnessed the signing of this directive, I am 18 years of age or older, and I am not: |
| 1. related to the declarant by blood or marriage; |
| 2. entitled to any portion of the declarant's estate according to the laws of intestate succession of any state or jurisdiction or under any will or codicil of the declarant; |
| 3. a beneficiary of a life insurance policy, trust, qualified plan, pay on death account, or transfer on death deed that is held, owned, made, or established by, or on behalf of, the declarant; |
| 4. entitled to benefit financially upon the death of the declarant; |
| 5. entitled to a right to, or interest in, real or personal property upon the death of the declarant; |
| 6. directly financially responsible for the declarant's medical care; |
| 7. a health care provider who is providing care to the declarant or an administrator at a health care facility in which the declarant is receiving care; or |
| 8. the appointed agent or alternate agent. |
| Witness Signature: | ________________________________________ |
If the witness is signing to confirm an oral directive, describe below the circumstances under which the directive was made. [Utah Code Ann. a7 75-2a-117]
| _____ | (your Agent) |
| * | You should discuss the document and your wishes with any person you want to designate as an Agent before doing so to assure they agree to act on your behalf. |
Utah Living Will FAQs
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How do I write a Living Will in Utah?
It is quick and easy to outline your medical preferences with a free Utah Living Will template from Rocket Lawyer:
- Make the document - Answer a few general questions, and we will do the rest
- Send or share - Review it with your healthcare agent(s) or get legal help
- Sign it and make it legal - Optional or not, witnesses and notarization are ideal
This route will often end up being much less time-consuming than finding and working with a traditional law firm. If necessary, you may fill out this Living Will on behalf of your spouse or another family member, and then help that person sign it when ready. Keep in mind that for a Living Will to be considered valid, the principal must be mentally competent at the time of signing. In the event that the principal has already been declared incompetent, a court-appointed conservatorship generally will be necessary. When facing such a situation, it's a good idea to talk to an Legal Pro.
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Why should I make a Living Will?
Every adult should have a Living Will. Even though it's challenging to acknowledge, a day may come when you are no longer able to make your own healthcare decisions. Here are some common occasions in which it may be helpful to make or update your Living Will:
- You've been given a terminal diagnosis
- You are facing the possibility of surgery or hospitalization
- You intend to live in a residential care facility
- You are aging or have declining health
Whether your Utah Living Will is being produced in response to a recent change in your health or as part of a long-term plan, notarization and witnesses are strongly recommended as a best practice for protecting this document and/or your agent if their privileges are questioned by a third party. Please note that a Living Will is not valid during pregnancy in Utah.
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Should I work with a lawyer to review my Living Will in Utah?
It’s a good idea to have important documents like your Utah Living Will reviewed before signing, so you fully understand your choices and help avoid unintended outcomes. The problem is that some attorneys may not review documents they didn’t prepare, while others may require a retainer or high hourly fees. This can make getting a legal review of your Utah Living Willdifficult and time-consuming.
Rocket Lawyer makes the process easier. With Rocket Lawyer, you can request a review from a Legal Pro or ask questions about your document. You can also use Rocket Copilot to review your document, identify potential issues, and check that everything is complete before signing.
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On average, how much would I usually have to pay to make a Living Will in Utah?
Attorney fees for drafting or reviewing an Utah Living Will can vary widely. Many lawyers charge hourly rates that may range from around $100 for less experienced attorneys to $350 or more per hour for highly experienced attorneys in major metropolitan areas. For more routine documents, some attorneys may offer flat-fee pricing.
The total cost will depend on several factors, including your location, the attorney’s experience, and the complexity of your agreement. More documents or situations involving negotiation will typically require more time and increase the overall cost.
With Rocket Lawyer, you can create a personalized Utah Living Will tailored to your specific needs—without the high cost typically associated with hiring a lawyer. If you have questions or want additional peace of mind, you can also get your document reviewed or ask a Legal Pro for guidance.
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Does a Living Will need to be notarized or witnessed in Utah?
The specific requirements and restrictions for Living Wills will be different by state; however, in Utah, your document needs to be signed by one witness. Your chosen witness must not be anyone who is financially responsible for your medical care or any healthcare provider or administrator of a facility where you are receiving care. It also should not be your spouse or another family member, heir, or beneficiary. As a basic standard, your witness will need to be over the age of 18 and should not simultaneously be your healthcare agent.
