Florida Statutory Living Will

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Last Updated: March 2, 2023.

Overview

This form is a living will—a legal document that allows an individual to express the individual's wishes regarding medical treatment in the event the individual becomes incapacitated or unable to communicate individual's wishes. In this form, the individual declares his or her desire that life-prolonging procedures be withheld or withdrawn in certain circumstances, and individual designates a surrogate to carry out these wishes if the individual is unable to do so directly. The statutory authority for this form is Florida Statutes 765.303.

Advantages of Using This Living Will

  1. Ensuring Autonomy and Respect for Wishes. Ensuring that an individual's wishes regarding medical treatment are respected, even if individual is unable to communicate their wishes at the time.

  2. Reducing Burden on Family Members. Reducing the burden on family members who may have to make difficult decisions about medical treatment on behalf of their loved one.

  3. Ensuring Autonomy and Respect for Wishes. Providing clarity and guidance to healthcare providers who may be unsure about what treatment options to pursue in the absence of clear instructions from the patient or their family.

Florida Statutory Living Will

LIVING WILL
(Florida Statutes 765.303)

Declaration made this _____ day of ___________________________________, 20_____, I, ___________________________________, willfully and voluntarily make known my desire that my dying not be artificially prolonged under the circumstances set forth below, and I do hereby declare that, if at any time I am incapacitated and (initial as applicable)

    _____ I have a terminal condition

or _____ I have an end-stage condition

or _____ I am in a persistent vegetative state

and if my primary physician and another consulting physician have determined that there is no reasonable medical probability of my recovery from such condition, I direct that life-prolonging procedures be withheld or withdrawn when the application of such procedures would serve only to prolong artificially the process of dying, and that I be permitted to die naturally with only the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 or to alleviate pain.

It is my intention that this declaration be honored by my family and physician as the final expression of my legal right to refuse medical or surgical treatment and to accept the consequences for such refusal.

In the event that I have been determined to be unable to provide express and informed consent regarding the withholding, withdrawal, or continuation of life-prolonging procedures, I wish to designate, as my surrogate to carry out the provisions of this declaration:


Name of Surrogate: ___________________________________

Address: ___________________________________

___________________________________

Zip Code: ________________

Phone: ___________________________________


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


Additional instructions (optional):

___________________________________

___________________________________

___________________________________

Name: ___________________________________

Signed: ___________________________________

Date: __________________


WITNESSES:

Witness #1:

Signature: ___________________________________

Printed Name: ___________________________________

Address: ___________________________________

Phone: ___________________________________


Witness #2:

Signature: ___________________________________

Printed Name: ___________________________________

Address: ___________________________________

Phone: ___________________________________


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