Hawaii Living Will Template
This document serves as a Living Will, designed in accordance with the Hawaii Revised Statutes, specifically the Uniform Health-Care Decisions Act (Chapter 327E). It is crafted to document the wishes of the undersigned with respect to medical treatment preferences in circumstances where they are unable to communicate those preferences themselves.
Part 1: Declaration
I, _________________ (the "Principal"), residing at ___________________________, being of sound mind, hereby make known my desires concerning medical treatment in situations where I am unable to make or communicate health care decisions.
Part 2: Treatment Preferences
In the event that I am in a terminal condition, a persistent vegetative state, or an end-stage condition, as defined in the laws of the State of Hawaii, and where my attending physician and another physician have determined that there is no reasonable hope of recovery, I direct that:
- Life-sustaining treatments, including artificial nutrition and hydration, be withheld or withdrawn, except as specified below:
__________________________________________________________
- I wish to receive the following types of treatment or care:
__________________________________________________________
Part 3: Signature
This Living Will shall be effective upon my incapacity to make health care decisions as certified in writing by my attending physician and another physician. I understand that I may revoke this Living Will at any time.
Signature: _______________________________ Date: _______________
Part 4: Witness Statement
I declare that the Principal voluntarily signed this document in my presence and appears to be of sound mind and under no duress, fraud, or undue influence. I am not the appointed health care agent, nor the attending physician or a health care provider for the Principal.
Name of Witness 1: _______________________________
Signature: _______________________________ Date: _______________
Name of Witness 2: _______________________________
Signature: _______________________________ Date: _______________