Montana Living Will Template
This Living Will is guided by the laws of the state of Montana, specifically the Montana Rights of the Terminally Ill Act. It is designed to express the desires concerning medical treatment of the individual named below, in the event that they become unable to communicate their wishes directly.
Please enter your information where applicable:
Full Name: ___________________________
Date of Birth: ___________________________
Address: ______________________________________________________
City: _______________________ State: MT Zip Code: _________
Living Will Declarations
I, ___________________________________, being of sound mind, make this statement as a directive to be followed if I become permanently unconscious, incapacitated, or otherwise unable to communicate or make decisions regarding my medical care. In such situations, it is my intention that this document shall be honored by my family, doctors, and other healthcare providers as the final expression of my legal right to refuse medical or surgical treatment and accept the consequences of such refusal.
I direct that all of the following preferences about my care be followed:
- Life-sustaining treatment should be withheld or withdrawn if I am in a persistent vegetative state, terminal condition, or if the burdens of treatment outweigh the expected benefits. I want my doctors to allow me to die naturally if my condition is deemed incurable or irreversible.
- I specifically do not want the following treatments if they only serve to prolong the dying process:
- Cardiopulmonary resuscitation (CPR)
- Mechanical ventilation
- Artificial nutrition and hydration
- Antibiotics
- I prefer to receive maximum comfort care, including pain relief, even if it hastens my death.
- I prefer to die at home if possible.
- I wish to donate my organs and tissues at the time of my death, if applicable.
Primary Physician: _________________________________________________
Contact Information: ______________________________________________
Signature
I understand the full import of this declaration and I am emotionally and mentally competent to make this declaration.
Date: ___________________________ Signature: ___________________________
Witness 1: ___________________________________________
Witness 2: ___________________________________________
Witnesses are required to verify that the declarant is known to them, signed this document in their presence, and appears to be of sound mind and not under duress, fraud, or undue influence.