Important Personal Preferences
The content provided here serves solely as a general example for sharing individual wishes related to life’s final stages. It is not legal advice and should not replace consultation with a qualified professional experienced in end-of-life planning or estate management. Laws and regulations vary by jurisdiction, and modifications may be necessary to adhere to local requirements. Use of this template is at your own risk, and we accept no liability for errors, omissions, or consequences from its use without professional guidance.
Please note: This sample document is for illustrative purposes only and may vary depending on individual preferences and legal requirements. Customize details as needed.
End of Life Wishes Document Sample
Parties Involved:
Name of Individual: Alex Johnson
Address: 789 Maple Street, Springfield, IL 62704
Health Care Proxy: Jamie Lee
Address: 101 Oak Avenue, Springfield, IL 62704
Personal Wishes:
The individual, Alex Johnson, wishes to be cared for in accordance with the instructions outlined here regarding medical treatments, life support, and other end-of-life considerations.
Specific End-of-Life Instructions:
Alex prefers to receive comfort care rather than aggressive life-sustaining treatments. Do not resuscitate (DNR) order is in effect unless otherwise specified. Organ donation preferences are to be honored as indicated.
Legal and Medical Proxy:
Jamie Lee is designated as the health care proxy to make decisions consistent with the stated wishes if Alex Johnson becomes unable to communicate.
Additional Notes:
- Copy of this document should be accessible to all relevant health care providers.
- Review and update this document periodically to reflect any changes in preferences.
- Keep this document in a known, safe location.
Springfield, ______________________
Alex Johnson
Jamie Lee (Health Care Proxy)