Illinois Living Will Template
This Living Will is made in accordance with the Illinois Living Will Act, 755 ILCS 35. It expresses my wishes regarding medical treatment in the event that I become unable to communicate my preferences.
I, [Your Full Name], born on [Your Date of Birth], residing at [Your Address], hereby declare this Living Will to be my instructions regarding medical treatment.
In the event that I am diagnosed with a terminal condition or am in a persistent vegetative state, I wish to make the following decisions regarding my medical care:
- I do not wish to receive life-sustaining treatment if:
- I am unable to make my own medical decisions.
- My condition is terminal and I am expected to die within a short period of time.
- I wish to receive comfort care, including:
- Pain relief.
- Support for emotional and spiritual needs.
In addition, I appoint the following individual as my healthcare agent to make decisions on my behalf if I am unable to do so:
[Agent's Full Name], residing at [Agent's Address], phone number [Agent's Phone Number].
If my appointed agent is unable or unwilling to act, I designate the following individual as an alternate:
[Alternate Agent's Full Name], residing at [Alternate Agent's Address], phone number [Alternate Agent's Phone Number].
This Living Will shall remain in effect until I revoke it in writing or until my death. I understand that I have the right to make changes to this document at any time.
Signed this [Day] day of [Month, Year].
______________________________
Signature
______________________________
Printed Name
Witnesses:
1. ______________________________
Printed Name: ____________________________
Address: _________________________________
2. ______________________________
Printed Name: ____________________________
Address: _________________________________