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Life Sustaining Statute, West Virginia

Free Printable Life Sustaining Statute, West Virginia FormFree Printable Life Sustaining Statute, West Virginia FormFree Printable Life Sustaining Statute, West Virginia Form

Life Sustaining Statute, West Virginia

A Life Sustaining Statute or a uniform living will is a legal document written by someone who is diagnosed with an illness that may be difficult to cure or has a chance to become a terminal illness. A life sustaining statute or uniform living will states the wishes of the person who is ill. It states what they would want to happen in the case that their illness does become terminal or that they pass the point of no return. This document states the types of medications he will be restricted to and from. It also states that if the person decided to prolong or shorten his or her life, that he or she did it willingly, of sound mind, has been informed of possible treatments and procedures, and understands all legal implications of his or her decisions. The document is generally written (this may vary among states) with the writer’s signature, City of residence, County of residence, State of residence, Social Security Number, the Date it was signed, and the names of the witnesses present during this event. It is then presented to a notary public for notarization and publishing. Finally, you are encouraged to keep multiple copies. Make sure that theses can be accessible with your doctor, lawyer, and family members.

A life sustaining statute is generally legal in most states and will generally be enforce and made in the presence of witnesses and a notary public. There is a general format when it come to life sustaining statutes but the details may differ depending on the state you are in. In the state of West Virginia, it is a general legal form.

Statutory Declaration in Conformance with West Virginia Natural Death Act, 16-30-3

DECLARATION OF _________________
Declaration made this __________ day of ______________ 20______. I, __________________, being of sound mind, willfully and voluntarily make known my desires that my dying shall not be artificially prolonged under the circumstances set forth below, do declare:

If at any time I should have an incurable injury, disease, or illness certified to be a terminal condition by two physicians who have personally examined me, one of whom is 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 artificially prolong the dying process, I direct that such procedures be withheld or withdrawn, and that I be permitted to die naturally with only the administration of nutrition, medication or the performance of any medical procedure deemed necessary to provide me with comfort, care or to alleviate pain.

In the absence of my ability to give directions regarding the use of such life-sustaining procedures, it is my intention that this declaration shall be honored by my family and physicians 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.

Address: _______________________
I did not sign the Declarant’s signature above for or at the direction of the Declarant. I am at least eighteen years of age and am not related to the Declarant by blood or marriage, entitled to any portion of the estate of the Declarant according to the laws of in testate succession of the State of West Virginia, or to the best of my knowledge under any will of Declarant or codicil thereto, or directly financially responsible for Declarant’s medical care. I am not the Declarant’s attending physician, an employee of the attending physician, nor an employee of the health facility in which the Declarant is a patient.



STATE OF ________________________
COUNTY OF _______________________

This day personally appeared before me, the undersigned authority, a Notary Public in and for ______________ County, ___________________________State, ______________________
_______________________________(Witnesses) who, being first being duly sworn, say that they are the subscribing witnesses to the declaration of ________________, the Declarant, signed, sealed and published and declared the same as and for his declaration, in the presence of both these affiants; and that these affiants, at the request of said Declarant, in the presence of each other, and in the presence of said Declarant, all present at the same time, signed their names as attesting witnesses to said declaration.

Affiants further say that this affidavit is made at the request of _________________, Declarant, and in his presence, and that ________________ at the time the declaration was executed, in the opinion of the affiants, of sound mind and memory, and over the age of eighteen years.

Taken, subscribed and sworn to before me by ___________________ (witness) and ____________________________ (witness) this _______ day of _______________, 20_____.
My commission expires: __________________
Notary Public
Statutory Declaration in Conformance with West Virginia Natural Death Act, 16-30-3
Review List

This review list is provided to inform you about this document in question and assist you in its preparation. This simple Life Sustaining Declaration is valid in West Virginia. Check with a local hospital or doctor’s office, as well as with an experienced medical attorney, to assure yourself of its compliance with current statute (s) in your state.

1. Make multiple copies. Give one to your doctor (s), the local hospital, and have others available through your attorney and family. Remember, these kinds of documents are needed in emergency situations at worst and under stressful circumstances at best. So be sure they are available to the appropriate people easily, when needed.

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