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Many people like to plan ahead, ensuring their wishes are honored in all aspects of life, including situations where they may not be able to express their desires directly. This is where the Connecticut Living Will form steps in as an essential tool. It empowers individuals to outline their preferences for medical treatment and end-of-life care in advance, securing their autonomy even when they can't communicate their wishes due to severe illness or incapacity. The form also alleviates the burden on family members and healthcare providers by providing clear instructions on the kind of medical interventions that should or should not be pursued. This document, specific to Connecticut residents, is legally binding and requires thorough consideration and understanding before completion. It is a declaration of one's healthcare preferences, covering a range of treatments and interventions, and paves the way for discussions about personal values and medical care expectations with loved ones and medical professionals. By addressing major aspects such as life support, pain management, and other critical care decisions, the Connecticut Living Will form offers a way for individuals to maintain control over their medical treatment, ensuring that their beliefs and preferences are respected during the most vulnerable times of their lives.

Document Sample

This Connecticut Living Will is established in accordance with the Connecticut Public Act No. 97-140, also known as the Connecticut Living Will and Health Care Instructions Act. This document allows you, the declarant, to specify your preferences regarding medical treatment and life-sustaining measures in the event you are unable to communicate your wishes due to incapacity or illness.

Declarant Information:

  • Full Name: ___________________________
  • Date of Birth: ________________________
  • Address: __________________________________________________
  • City: _____________________ State: CT Zip Code: ____________

Health Care Instructions:

I, _____________________ (full name), being of sound mind, hereby provide the following instructions concerning my health care decisions:

  1. Life-Sustaining Treatment:

    In the event I am in a terminal condition, permanently unconscious, or in a condition where the risks and burdens of treatment would outweigh the expected benefits, I direct that:

    • My health care provider shall/ shall not (circle one) administer life-sustaining treatment that could extend my life, including artificial nutrition and hydration.
  2. Pain Relief:

    I wish to receive medication or any intervention to alleviate pain or discomfort at all times, even if such treatment might hasten my death.

  3. Other Instructions:

    ________________________________________________________________

    ________________________________________________________________

Appointment of Health Care Representative:

I hereby appoint the following individual as my Health Care Representative to make health care decisions for me in accordance with this Living Will should I become unable to make my own decisions:

  • Name: ___________________________
  • Relationship: _____________________
  • Primary Phone: ___________________
  • Alternate Phone: __________________

This Living Will is signed voluntarily and without any coercion or undue influence. I understand the nature and purpose of this document and the consequences of my decisions.

Signature of Declarant: ___________________________ Date: ____________

Witness Declaration:

This document was signed in my presence. The declarant, in my opinion, is of sound mind and under no duress, fraud, or undue influence.

  • Witness 1 Signature: ___________________________ Date: ____________
  • Witness 1 Printed Name: _________________________
  • Witness 2 Signature: ___________________________ Date: ____________
  • Witness 2 Printed Name: _________________________

Note: Two witnesses are required for the execution of this document, neither of whom shall be a health care provider, conservator, or an heir.

PDF Information

Fact Number Fact Detail
1 Connecticut's Living Will is legally known as an "Advance Health Care Directive".
2 It allows individuals to outline their preferences for medical treatment should they become unable to make decisions for themselves.
3 The governing law for Living Wills in Connecticut is Connecticut General Statutes Section 19a-575a.
4 To be valid, the Living Will must be signed by the declarant (person creating the will) and witnessed by two individuals who are not beneficiaries.
5 The document can specify preferences for specific treatments, including the use of life-sustaining equipment.
6 Individuals have the right to appoint a Health Care Representative to make decisions on their behalf.
7 This document can be revoked by the declarant at any time by a signed and dated written document or by orally informing the attending physician.
8 Connecticut's Living Will becomes effective when the declarant is determined to be incapacitated and unable to communicate their healthcare decisions.
9 Healthcare providers are legally obligated to follow the instructions laid out in the Living Will as long as they conform with reasonable medical standards.
10 If there is no Living Will, healthcare decisions will be made by a spouse, adult child, parent, adult sibling, or another legally appointed decision-maker in that order of priority.

Instructions on How to Fill Out Connecticut Living Will

Filling out a Connecticut Living Will is an essential step for ensuring your health care preferences are respected and followed in the event you are unable to communicate your desires yourself. This document allows you to make clear decisions about the type of medical care you want to receive, particularly regarding life support and other critical treatments. In Connecticut, completing a Living Will is straightforward, but it's important to follow each step carefully to ensure your wishes are properly documented and legally binding.

  1. First, gather necessary information including your full legal name, address, date of birth, and social security number.
  2. Read the introduction section of the form thoroughly to understand the purpose of a Living Will and how it operates under Connecticut law.
  3. In the section labeled "Life Support Systems," clearly indicate whether you wish to receive life support if you are in a terminal condition or a permanent unconscious state. Check the appropriate box to reflect your wishes.
  4. If you have specific desires about receiving or not receiving particular types of life-sustaining treatment such as mechanical breathing, tube feeding, or resuscitation, include these details in the provided space.
  5. Assign a Health Care Representative by providing their full name, relationship to you, address, and telephone number. This person will have the authority to make health care decisions on your behalf, in accordance with your Living Will, if you're unable to communicate your wishes.
  6. Include the name, address, and telephone number of an alternate Health Care Representative as a precaution, in case the primary representative is unable or unwilling to fulfill their duties.
  7. Sign and date the form in the presence of two witnesses, who must be adults and should not be your relatives by blood, marriage, or adoption, your beneficiaries, or responsible for your medical bills. The witnesses must also sign and date the form, attesting that you are willingly and under no duress or undue influence signing the Living Will.
  8. Lastly, discuss your Living Will with your family, your Health Care Representative, and your primary care physician, and provide them each with a copy. This ensures that your wishes are understood and easily accessible when needed.

By following these steps, your Living Will can serve as a clear expression of your health care preferences, providing peace of mind to you and your loved ones. Remember, this document can be revised or revoked by you at any time, should your wishes or circumstances change. It is advisable to review your Living Will periodically to ensure it always reflects your current wishes.

More About Connecticut Living Will

  1. What is a Connecticut Living Will?

    A Connecticut Living Will is a legal document that outlines your wishes regarding medical care if you become unable to communicate them yourself. This might include treatments you want or don't want, such as life support, in the event of a terminal illness or severe injury.

  2. Who should have a Living Will?

    Anyone over the age of 18 can and should consider creating a Living Will. It's especially important for those with strong feelings about their end-of-life care, or those with health conditions that might impair their ability to communicate their healthcare preferences in the future.

  3. How can I create a Living Will in Connecticut?

    To create a Living Will in Connecticut, you need to complete a standard form that captures your healthcare preferences. This document should be signed in the presence of two witnesses, neither of whom should be your healthcare provider, an employee of your healthcare provider, the operator of a community care facility, or an employee of an operator of a community care facility.

  4. Do I need a lawyer to make a Living Will?

    No, you do not need a lawyer to make a Living Will in Connecticut. However, consulting with a legal professional can provide valuable guidance, ensuring that your wishes are clearly stated and that the document meets all legal requirements.

  5. What should I do with my Living Will after it's signed?

    After your Living Will is signed, you should keep the original in a safe but accessible place. Inform your healthcare provider, close family members, and healthcare agent (if you have designated one) about the document and its location. You might also consider giving copies to these individuals for their records.

  6. Can I change my Living Will?

    Yes, you can change or revoke your Living Will at any time. To do so, it's recommended that you destroy the old document and create a new one that reflects your current wishes. Make sure to inform all relevant parties of the change.

  7. What happens if I don't have a Living Will?

    If you don't have a Living Will and become unable to express your healthcare wishes, decisions about your care will typically be made by your closest family members or a court-appointed guardian. This might not align with what you would have chosen for yourself.

  8. Is a Connecticut Living Will the same as a Healthcare Power of Attorney?

    No, they are not the same. A Living Will outlines your wishes regarding medical treatment, while a Healthcare Power of Attorney appoints someone to make healthcare decisions on your behalf. Many people choose to have both documents to cover different aspects of their healthcare planning.

Common mistakes

The Connecticut Living Will form stands as a pivotal document, empowering individuals to communicate their preferences pertaining to healthcare, should they become unable to voice these decisions themselves. In the process of completing this form, however, several common mistakes frequently emerge, potentially complicating or even thwarting the execution of one's healthcare wishes. Highlighting these errors and offering clarity on how to avoid them can significantly enhance the efficacy of this critical document.

  1. Not fully understanding the document's scope: A profound misunderstanding that often arises is the failure to grasp the full extent of what the Living Will encompasses. This form doesn't merely express wishes about life-saving treatments but also outlines preferences for palliative care, situations involving terminal illness, permanent unconsciousness, and end-of-life care. Individuals filling out the form must recognize the breadth of decisions covered, ensuring their instructions are comprehensive and reflective of their values and wishes.

  2. Lack of clarity and specificity: Ambiguity serves as a substantial obstacle in the execution of healthcare directives. To mitigate misinterpretation, individuals should articulate their wishes with the utmost clarity and precision. Rather than using broad terms like "life-sustaining treatment," specifying particular interventions such as mechanical ventilation, resuscitation efforts, or artificial nutrition and hydration can greatly enhance the effectiveness and enforceability of the document.

  3. Omitting discussions with healthcare providers and loved ones: A crucial step that is sometimes overlooked is engaging in comprehensive conversations with healthcare professionals and close family members or friends about the content and intentions of the Living Will. These discussions ensure everyone involved understands the individual's healthcare preferences, thereby facilitating a unified approach to decision-making in challenging circumstances.

  4. Failure to appoint a healthcare representative: While the Living Will is instrumental in outlining healthcare wishes, combining it with the appointment of a healthcare representative can significantly reinforce one’s intentions. This appointed individual plays a key role in advocating for the person’s healthcare preferences when they cannot communicate themselves, making it essential to choose someone trustworthy and aligned with the individual's values and wishes.

  5. Neglecting to review and update the document: Life circumstances and healthcare preferences can evolve over time, rendering a once reflective Living Will inadequate or outdated. Individuals should periodically review and, if necessary, revise their Living Will to ensure it accurately represents their current healthcare wishes. This includes updating the document in light of new medical diagnoses, changes in personal relationships, or after significant life events.

By avoiding these common mistakes, individuals can greatly enhance the clarity and effectiveness of their Connecticut Living Will, thereby ensuring their healthcare wishes are known and respected. This proactive approach not only provides peace of mind to the person creating the Living Will but also to their loved ones and healthcare providers, facilitating a compassionate and coherent approach to future healthcare decisions.

Documents used along the form

When preparing a Connecticut Living Will, it is often beneficial to consider other documents that can complement and support one's healthcare and estate planning wishes. These documents together form a comprehensive plan that addresses various aspects of one’s healthcare and personal matters, ensuring that their wishes are respected and followed. The following is a list of documents commonly used alongside a Connecticut Living Living Will.

  • Healthcare Power of Attorney: This document appoints someone to make healthcare decisions on your behalf if you are unable to do so yourself. Unlike a Living Will, which is limited to end-of-life decisions, a Healthcare Power of Attorney covers a broader range of health decisions.
  • Durable Power of Attorney for Finances: Similar to the Healthcare Power of Attorney but focused on financial affairs, this document designates a person to manage your finances if you become incapacitated. It can cover tasks such as paying bills, managing investments, and conducting financial transactions.
  • Do Not Resuscitate (DNR) Order: A DNR order is a medical order that tells healthcare professionals not to perform CPR if your breathing stops or if your heart stops beating. It is usually for individuals with a terminal illness or specific health condition.
  • Organ and Tissue Donation Registration: This specifies your wishes regarding organ and tissue donation. It can be indicated on your driver's license or registered in your state’s organ donor registry.
  • HIPAA Release Form: The Health Insurance Portability and Accountability Act (HIPAA) protects your medical information. A HIPAA Release Form allows healthcare providers to share your health information with individuals you designate.
  • Appointment of Health Care Representative: Often combined with a Healthcare Power of Attorney, this document explicitly names a representative to make healthcare decisions for you, ensuring that someone you trust is authorized to act on your behalf if necessary.
  • Living Trust: A Living Trust allows you to place assets in a trust to be managed by a trustee for the benefit of your chosen beneficiaries. It can help avoid probate and manage your estate both during your life and after your passing..

Together, these documents provide a holistic approach to personal and healthcare planning. While a Living Will addresses specific end-of-life concerns, incorporating these additional documents can ensure all aspects of your health and estate are managed according to your wishes. For a plan that accurately reflects your desires and is executed effectively, consideration of each document’s role and how it complements a Living Will is crucial.

Similar forms

The Connecticut Living Will form is similar to other advance directive documents that serve as legal instruments to record a person's preferences for medical treatment in situations where they are no longer able to make decisions for themselves due to incapacitation. These include but are not limited to the Health Care Proxy, Durable Power of Attorney for Health Care, and Do Not Resuscitate (DNR) Orders. Each document, while aligned in purpose, addresses different aspects of medical care preferences and decision-making authority.

Health Care Proxy: This document is very similar to a Living Will in that it allows a person to designate another individual to make health care decisions on their behalf should they become unable to do so. The similarity lies in the fundament that both forms enable the principal to assert control over their medical treatment in advance. However, the distinct difference lies in the scope; the Health Care Proxy specifically appoints a surrogate decision-maker, whereas the Living Will generally outlines the types of medical interventions the individual does or does not want to receive.

Durable Power of Attorney for Health Care: Much like the Health Care Proxy, the Durable Power of Attorney for Health Care enables individuals to appoint someone to make decisions about their health care if they are incapacitated. This document is similar to the Connecticut Living Will because both provide mechanisms for planning ahead in terms of medical care. The crucial difference, however, is that the Durable Power of Attorney for Health Care covers a broader range of decisions, not limited to those at the end of life, and can also include decisions about hiring caregivers, facility placements, and even financial matters related to health care.

Do Not Resuscitate (DNR) Orders: A DNR order is a medical order signed by a physician that instructs health care providers not to perform cardiopulmonary resuscitation (CPR) if a patient's breathing stops or if the heart stops beating. It is similar to a Living Will in its focus on end-of-life care preferences. However, the Living Will is broader, covering various treatments and care options, whereas the DNR is specifically focused on the absence of CPR in the event of cardiac arrest or respiratory arrest.

Dos and Don'ts

Filling out a Living Will in Connecticut is a significant step in planning for one's future health care. It's crucial to approach this task with care. Here are some helpful dos and don'ts to keep in mind:

Do:

  • Read the instructions carefully. It might seem obvious, but understanding every detail of the form is key to accurately conveying your wishes.
  • Talk to your family and health care providers. Before you make decisions, discuss your preferences with those who might be affected or those who will be part of carrying out your wishes.
  • Be clear and specific. Ambiguity in a Living Will can lead to confusion and complications. Clearly state your health care desires.
  • Consider consulting a lawyer. Although it's not mandatory, getting legal advice can ensure your Living Will meets all legal requirements and truly reflects your wishes.
  • Sign in the presence of witnesses or a notary, as required by Connecticut law. This step is crucial for your Living Will to be considered valid.

Don't:

  • Rush the process. Take your time to think about what you really want and how best to communicate that.
  • Use vague language. Unclear statements can lead to your wishes not being followed as you intended.
  • Forget to update your Living Will. As your life circumstances change, so too might your health care preferences. Remember to review and adjust your document accordingly.
  • Leave your Living Will in a safe but inaccessible place. Make sure that your health care agent, family, and primary doctor have copies or know where to find it.
  • Assume your doctors are familiar with your wishes without discussion. Even if you've filled out the form thoroughly, have a conversation with your doctors to ensure they understand your preferences.

Misconceptions

When discussing Living Wills, especially within the state of Connecticut, several misconceptions commonly arise. These misunderstandings can significantly affect an individual's decision-making process regarding their own health care preferences in the event they are unable to communicate those wishes. It’s important to clarify these points to ensure individuals are well-informed and can make decisions that truly reflect their desires.

  • Misconception: A Living Will is only for the elderly.

    Many people believe that only the elderly need to draft a Living Will. This assumption fails to account for unexpected situations where individuals, regardless of age, might become unable to communicate their health care wishes due to accidents or sudden illnesses. A Living Will is a proactive measure for adults at any stage of life to ensure their health care preferences are known and respected.

  • Misconception: Having a Living Will means you won’t receive any medical treatment.

    This misunderstanding could not be further from the truth. A Living Will specifically outlines the types of medical interventions an individual desires or does not desire in certain situations. It does not equate to refusing all forms of medical treatment. Instead, it guides healthcare providers to offer the treatment that aligns with the individual's preferences, which could include pain management, hydration, and other forms of supportive care.

  • Misconception: Your family can override your Living Will.

    In Connecticut, a Living Will is a legally binding document that communicates a person's wishes regarding life support and other medical treatments in the event they are incapacitated. While family members and loved ones are often consulted in difficult medical situations, a valid Living Will takes precedence over others' opinions on what they believe the incapacitated person would have wanted.

  • Misconception: A Living Will is the same as a Last Will and Testament.

    The confusion between these two documents is common but important to clarify. A Living Will pertains strictly to health care decisions during an individual's lifetime, particularly concerning end-of-life care. On the other hand, a Last Will and Testament deals with the distribution of an individual's property after their death. These are separate legal documents serving different purposes.

  • Misconception: You need a lawyer to create a Living Will.

    Although consulting with a lawyer can be beneficial, especially for complex cases, it is not a requirement to create a Living Will in Connecticut. Individuals can complete a Living Will form on their own as long as it meets state requirements, including being signed in the presence of witnesses not related by blood or marriage and not entitled to any portion of the person’s estate.

  • Misconception: Once created, a Living Will cannot be changed.

    People often mistakenly believe that after creating a Living Will, it becomes set in stone. However, Connecticut law allows individuals to revise or revoke their Living Will at any time, provided they are mentally competent to do so. This ensures that an individual's current health care preferences are always reflected, even if they change over time.

Key takeaways

Filling out a Connecticut Living Will can be an important step in ensuring your healthcare preferences are respected and followed. Here are six key takeables to keep in mind.

  • Understanding the purpose is crucial: A Living Will allows you to document your wishes regarding medical treatment in scenarios where you can't communicate them yourself, especially in end-of-life situations. It's your voice when you can't physically speak.

  • Know who can fill it out: Any competent individual over the age of 18 or an emancipated minor in Connecticut can create a Living Will. It's a personal decision and document that reflects your specific healthcare preferences.

  • Choose a healthcare representative wisely: This person will have the authority to make healthcare decisions on your behalf, should you become unable to do so. Ensure it's someone you trust and who understands your wishes clearly.

  • Be specific about your medical treatment preferences: The more detailed you are in your Living Will, the easier it will be for healthcare providers and your family to follow your wishes. This can include decisions about life support, resuscitation, and other interventions.

  • Signing requirements: To be legally valid in Connecticut, your Living Will must be signed in the presence of two witnesses, who also need to sign the form. These witnesses cannot be your healthcare representative, a potential heir, or anyone responsible for your medical bills.

  • Revisiting and revising your Living Will: Life circumstances and preferences change, and it's essential to review and possibly update your Living Will accordingly. Whether it's a change in health status, family situation, or simply a change of mind, your Living Will should accurately reflect your current wishes.

Remember, creating a Living Will is a proactive step towards ensuring your healthcare wishes are known and respected. It's about taking control over difficult decisions and making them easier for the people you love. Consider discussing your intentions with a healthcare provider or a legal professional to ensure your Living Will accomplishes what you intend it to.

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