OTHER NAMESPennsylvania Advance DirectivePennsylvania Advance Healthcare DirectivePennsylvania Medical DirectivePennsylvania Advance Medical DirectivePennsylvania Advance Health Care Directive
What is a Pennsylvania Living Will?
A Pennsylvania Living Will is a legal document that sets forth your wishes regarding health care, such as your refusal or acceptance of a certain medical treatment, along with the (optional) appointment of a trusted healthcare decision maker or "agent."
The individual making a Living Will is known as the "principal," while the person or organization receiving permission to carry out the principal's wishes is called the "agent." Designed for Pennsylvania residents, this Living Will can be used in Montgomery County, Philadelphia County, Allegheny County, and in every other county or municipality throughout the state. Any Pennsylvania Living Will form from Rocket Lawyer can be tailored for your specific situation. This essential document will provide verification of your decisions to healthcare institutions, and it will certify that your selected representatives have been given the authority to act in your interest.
When to use a Pennsylvania 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.
What we’ll cover
Sample Pennsylvania Living Will
The terms in your document will update based on the information you provide
This document has been customized over 85.4K times
Legally binding and enforceable
Complies with relevant laws
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INTRODUCTORY REMARKS ON
HEALTH CARE DECISION MAKING
You have the right to decide the type of health care you want. Should you become unable to understand, make or communicate decisions about medical care, your wishes for medical treatment are most likely to be followed if you express those wishes in advance by:
(1) naming a health care agent to decide treatment for you; and
(2) giving health care treatment instructions to your health care agent or health care provider.
An advance health care directive is a written set of instructions expressing your wishes for medical treatment. It may contain a health care power of attorney, where you name a person called a "health care agent" to decide treatment for you, and a living will, where you tell your health care agent and health care providers your choices regarding the initiation, continuation, withholding or withdrawal of life-sustaining treatment and other specific directions.
You may limit your health care agent's involvement in deciding your medical treatment so that your health care agent will speak for you only when you are unable to speak for yourself or you may give your health care agent the power to speak for you immediately. This combined form gives your health care agent the power to speak for you only when you are unable to speak for yourself. A living will cannot be followed unless your attending physician determines that you lack the ability to understand, make or communicate health care decisions for yourself and you are either permanently unconscious or you have an end-stage medical condition, which is a condition that will result in death despite the introduction or continuation of medical treatment. You, and not your health care agent, remain responsible for the cost of your medical care.
If you do not write down your wishes about your health care in advance, and if later you become unable to understand, make or communicate these decisions, those wishes may not be honored because they may remain unknown to others.
A health care provider who refuses to honor your wishes about health care must tell you of its refusal and help to transfer you to a health care provider who will honor your wishes.
You should give a copy of your advance health care directive (a living will, health care power of attorney or a document containing both) to your health care agent, your physicians, family members and others whom you expect would likely attend to your needs if you become unable to understand, make or communicate decisions about medical care. If your health care wishes change, tell your physician and write a new advance health care directive to replace your old one. It is important in selecting a health care agent that you choose a person you trust who is likely to be available in a medical situation where you cannot make decisions for yourself. You should inform that person that you have appointed him or her as your health care agent and discuss your beliefs and values with him or her so that your health care agent will understand your health care objectives.
You may wish to consult with knowledgeable, trusted individuals such as family members, your physician or clergy when considering an expression of your values and health care wishes. You are free to create your own advance health care directive to convey your wishes regarding medical treatment. The following form is an example of an advance health care directive that combines a health care power of attorney with a living will.
NOTES ABOUT THE USE OF THIS FORM
If you decide to use this form or create your own advance health care directive, you should consult with your physician and your attorney to make sure that your wishes are clearly expressed and comply with the law.
If you decide to use this form but disagree with any of its statements, you may cross out those statements.
You may add comments to this form or use your own form to help your physician or health care agent decide your medical care.
This form is designed to give your health care agent broad powers to make health care decisions for you whenever you cannot make them for yourself. It is also designed to express a desire to limit or authorize care if you have an end-stage medical condition or are permanently unconscious. If you do not desire to give your health care agent broad powers, or you do not wish to limit your care if you have an end-stage medical condition or are permanently unconscious, you may wish to use a different form or create your own. YOU SHOULD ALSO USE A DIFFERENT FORM IF YOU WISH TO EXPRESS YOUR PREFERENCES IN MORE DETAIL THAN THIS FORM ALLOWS OR IF YOU WISH FOR YOUR HEALTH CARE AGENT TO BE ABLE TO SPEAK FOR YOU IMMEDIATELY. In these situations, it is particularly important that you consult with your attorney and physician to make sure that your wishes are clearly expressed.
This form allows you to tell your health care agent your goals if you have an end-stage medical condition or other extreme and irreversible medical condition, such as advanced Alzheimer's disease. Do you want medical care applied aggressively in these situations or would you consider such aggressive medical care burdensome and undesirable?
You may choose whether you want your health care agent to be bound by your instructions or whether you want your health care agent to be able to decide at the time what course of treatment the health care agent thinks most fully reflects your wishes and values.
If you are a woman and diagnosed as being pregnant at the time a health care decision would otherwise be made pursuant to this form, the laws of this Commonwealth prohibit implementation of that decision if it directs that life-sustaining treatment, including nutrition and hydration, be withheld or withdrawn from you, unless your attending physician and an obstetrician who have examined you certify in your medical record that the life-sustaining treatment:
(1) will not maintain you in such a way as to permit the continuing development and live birth of the unborn child;
(2) will be physically harmful to you; or
(3) will cause pain to you that cannot be alleviated by medication.
A physician is not required to perform a pregnancy test on you unless the physician has reason to believe that you may be pregnant.
Pennsylvania law protects your health care agent and health care providers from any legal liability for following in good faith your wishes as expressed in the form or by your health care agent's direction. It does not otherwise change professional standards or excuse negligence in the way your wishes are carried out. If you have any questions about the law, consult an attorney for guidance.
This form and explanation is not intended to take the place of specific legal or medical advice for which you should rely upon your own attorney and physician.
I, , being of sound mind, willfully and voluntarily make this Declaration for my care to be followed if I become unable to express my desires directly as a consequence of physical or mental incapacity or disability, regardless of whether this is caused by illness, accident, or other injury. This document is intended to direct all persons who are involved with my care including my relatives, physicians or personal representatives which I have appointed, or which hereafter may be appointed by the courts.
If I am unable to participate in decisions relating to my care by reason of illness, incapacity or disability, such decisions shall be made in accordance with this Declaration. If this Declaration conflicts with the desires of my relatives, or with either hospital or other institutional policies, or the principles of those providing my care, I expect my Declaration to prevail, unless it is clearly contrary to existing law.
I direct that all life prolonging procedures be withheld or withdrawn.I direct my attending physician or attending advanced practice registered nurse, to continue to prolong my life as long as possible within the limits of generally accepted health care standards.
I direct that treatment be limited to measures to keep me comfortable and to relieve pain, including any pain that might occur by withholding or withdrawing life-sustaining treatment.
In addition, if I am in the condition or state described above, I feel especially strong about the following forms of treatment:
1. I want heart-lung resuscitation.
2. I want mechanical respiration.
3. I want tube feeding or any other artificial or invasive form of nutrition (food) or hydration (water).
4. I want blood/blood products.
5. I want any form of surgery or invasive diagnostic tests.
6. I want kidney dialysis treatment.
7. I want antibiotics.
8. I want to make anatomical gifts:
I realize that if I do not specifically indicate my preference regarding any of the forms of treatment listed above, I may receive that form of treatment.
do not do I hereby designate currently residing at , , , as my Surrogate. If the person designated as my Surrogate is not able to act, I designate currently residing at , , , as my Alternate Surrogate.SUBJECT TO THE HEALTH CARE TREATMENT INSTRUCTIONS DESCRIBED ABOVE :
. To authorize, withhold or withdraw medical care and surgical procedures.
. To authorize, withhold or withdraw nutrition (food) or hydration (water) medically supplied by tube through my nose, stomach, intestines, arteries or veins.
. To authorize my admission to or discharge from a medical, nursing, residential or similar facility and to make agreements for my care and health insurance for my care, including hospice and/or palliative care.
. To hire and fire medical, social service and other support personnel responsible for my care.
. To request that a physician responsible for my care issue a do-not-resuscitate (DNR) order, including an out-of-hospital DNR order, and sign any required documents and consents.
. DESIGNATION OF ALTERNATE SURROGATE. If my health care agent is not readily available or if my health care agent is my spouse and an action for divorce is filed by either of us after the date of this document, I appoint the following person(s) named below in the order named.
FIRST ALTERNATE SURROGATE
SECOND ALTERNATE SURROGATE
. GUIDANCE FOR HEALTH CARE AGENT.
If I have an end-stage medical condition or other extreme irreversible medical condition, my goals in making medical decisions are as follows:
Initials _______ I agree Initials _______ I disagree
. PERSONAL STATEMENT. I want to make a personal statement.
By writing this advance directive, I inform those who may become entrusted with my health care of my wishes and intend to ease the burdens of decision making which this responsibility may impose. I understand the purpose and effect of this document and sign it knowingly, voluntarily and after careful deliberation.
. HOLD HARMLESS. Pennsylvania law protects my health care agent and health care providers from any legal liability for their good faith actions in following my wishes as expressed in this form or in complying with my health care agent's direction. On behalf of myself, my executors and heirs, I further hold my health care agent and my health care providers harmless and indemnify them against any claim for their good faith actions in recognizing my health care agent's authority or in following my treatment instructions.
IN WITNESS WHEREOF, I, , hereunto subscribe my name and acknowledge this instrument as my Advance Health Care Declaration on this _____ day of _______________, _____.
STATEMENT OF WITNESSES
or the person on behalf of and at the direction of knowingly and voluntarily signed this writing by signature or mark in our presence on this day.
Two witnesses at least 18 years of age are required by Pennsylvania law and should witness your signature in each other's presence. A person who signs this document on behalf of and at the direction of a principal may not be a witness. (It is preferable if the witnesses are not your heirs, nor your creditors, nor employed by any of your health care providers.)
A notary public
You should discuss the document and your wishes with any person you want to designate as a Surrogate before doing so to assure they agree to act on your behalf.
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Pennsylvania Living Will FAQs
How do I write a Living Will in Pennsylvania?
It is fast and easy to record your medical preferences using a free Pennsylvania Living Will template from Rocket Lawyer:
Make your Living Will - Answer a few basic questions, and we will do the rest
Send and share - Review the document with your healthcare agent(s) or seek legal help
Sign and make it legal - Required or not, witnesses/notarization are recommended
This route, in many cases, will end up being notably less expensive and less time-consuming than working with your average law firm. If necessary, you may prepare this Living Will on behalf of your spouse, an elderly parent, or another relative, and then have that person sign after you've drafted it. Please note that for this document to be considered legally valid, the principal must be mentally competent when they sign. If the principal is already incapacitated and unable to make their own decisions, a conservatorship generally will be required. When managing such a scenario, it would be important to speak to an attorney .
Do I need to have a Living Will?
Anyone who is over 18 ought to have a Living Will in place. Even though it is difficult to think about, there might come a time when you cannot make important decisions on your own. Here are some typical occasions in which you might find it useful to make or update your Living Will:
You have been given a terminal diagnosis
You are expecting to undergo a medical procedure that requires anesthesia
You have plans to move into a residential care facility
You are aging or have declining health
Whether your Pennsylvania Living Will has been drafted as part of a forward-looking plan or created as a result of a recent change in your health, notarization and/or witnesses can help to protect your agent if their privileges and authority are questioned by a third party. Please note that in Pennsylvania, a Living Will is not valid when the principal is pregnant.
Do I need a lawyer to review my Living Will in Pennsylvania?
Making a Living Will is normally straightforward, but you or your agent(s) may still need legal advice. It may depend on whom you ask, but often, some lawyers won't even agree to review your document if they were not the author. An easier approach might be through the Rocket Lawyer attorney network. As a Premium member, you can ask for advice from an attorney with relevant experience or get answers to additional questions related to your Living Will. As always, Rocket Lawyer is here for you.
What might I typically pay for a lawyer to help me make a Living Will in Pennsylvania?
The cost of hiring a traditional legal provider to write a Living Will might be anywhere between $200 and $1,000, depending on where you are located. Different from many other sites that you may come across, Rocket Lawyer offers more than a Living Will template. If you ever require assistance from a lawyer, your Premium membership provides up to a 40% discount when you hire an Rocket Lawyer network attorney.
Would I have to do anything else after I have written a Pennsylvania Living Will?
After completing this document with Rocket Lawyer, you'll be able to open it anytime and anywhere. You may also take any or all of these actions related to your document: editing it, printing it out, or signing it. Alongside your Pennsylvania Living Will form, there is a set of helpful tips to follow while finalizing your document. Make sure to provide a final copy of your fully signed document to your agent(s) and care providers.
Does a Living Will need to be notarized or witnessed in Pennsylvania?
The guidelines for Living Wills will be different by state; however, in Pennsylvania, your document usually needs to be signed by two witnesses. The principal may sign by signature or by mark, or they may direct another person to sign on their behalf. Where applicable, the witnesses to a Living Will must not include the person who signed the document on your behalf. As a general principle, your witnesses will need to be over the age of 18, and none should simultaneously be acting as your agent.
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