Living Will Declaration Template
Translated by
ScribdTranslationsLiving Will Declaration Template
Translated by
ScribdTranslationsLIVING WILL
I ________________________________, citizen of nationality
__________________, of legal age, with identity card No. / Passport ___________
freely and voluntarily I make known my decision that:
If, due to illness or accident, I were to find myself in an irrecoverable clinical situation and/or in
circumstances in which I cannot express my will regarding exams and treatments that
they want to apply to me; and, if my treating doctor or another consulted doctor, a specialist in the
matter, regardless of the case, have determined that there is no reasonable probability of
recovery of such conditions, I order that the procedures not be applied to me
vital support, if these only serve to artificially prolong the process of dying, and
let me die naturally and only be given treatments and assistance
suitable to alleviate any suffering that one may have.
I wish that this final event of my existence takes place in an environment of peace,
with spiritual assistance and the company of my loved ones.
It is my intention that this declaration be respected by my family and the health personnel, as
the final expression of my right to refuse medical or surgical treatment, accepting the
consequences of such denial.
In the event that I become unable to expressly ratify what is stated here
manifested, that is to say the decision not to receive the procedures to artificially prolong
my life, I want to designate as my representative to carry out these provisions:
Nombre:______________________________________
Address:____________________________________
Teléfono:____________________________
Citizenship card:________________________
I understand the full meaning of this decision and I am emotionally and mentally competent.
to make this statement.
I reserve the right to revoke this document whenever I deem it appropriate.
Firma:_________________________ Fecha:__________________________
The undersigned, of legal age, declare that the person who signs this document
has made fully aware, without us being able to perceive any kind of coercion in
his decision.