Sample Living Will for Lousisiana residents:

Below is a standard Living Will form that you are allowed to use.  It is your responsibility to assure that it is up to date and complies with Louisiana Law.  This is only a basic form and may not adequately meet the needs of all residents.


 Declaration made this ____ day of ___________, 201_,

I, _____________________, being of sound mind, willfully and voluntarily make known my desire that my dying shall not be artificially prolonged under the circumstances set forth below and do hereby declare:

If at any time I should have an incurable injury, disease or illness, or be in a continual profound comatose state with no reasonable chance of recovery, certified to be a terminal and irreversible condition by two physicians who have personally examined me, one of whom shall be my attending physician, and the physicians have determined that my death will occur whether or not life-sustaining procedures are utilized and where the application of life-sustaining procedures would serve only to prolong artificially the dying process, I direct (initial one only):

___That all life sustaining procedures and hydration be withdrawn so that food and water will not be administered invasively.

___That life-sustaining procedures, except nutrition and hydration, be withheld or withdrawn so that food and water can be administered invasively.

I further direct that I be permitted to die naturally with only the administration of medication or the performance of any medical procedure deemed necessary to provide me with comfort care.

In the absence of my ability to give directions regarding the use such life-sustaining procedures, it is my intention that this declaration shall be honored by my family and physician(s) as the final expression of my legal right to refuse medical or surgical treatment and accept the consequences from such refusal.          .

I understand the full import of this declaration, and I am emotionally and mentally competent to make this declaration.

Signed:   __________________________

City of _____________, Parish of _____________, State of Louisiana.

The declarant has been personally known to me, and I believe him or her to be of sound mind.





Disclaimer:  You should always confer with an attorney on any legal document and confirm that Louisiana Law has not been modified prior to using a form document.