Decline life support, Ohio
- Full legal name
- Jane A. Smith
- State or country
- Ohio
- Conditions it covers
- terminal; unconscious
- Life-sustaining treatment
- Do not prolong
- Tube feeding and IV fluids
- Do not provide
- Full pain relief even if it may hasten death
- Yes
- Organ and tissue donation
- No donation
Result Your living will draft: LIVING WILL (ADVANCE DIRECTIVE)
I, Jane A. Smith, of Ohio, being of sound mind, make this declaration voluntarily.
1. When this applies. These instructions apply if my attending physician and a second physician find that I am unable to communicate my decisions and I have:
– a terminal condition from which there is no reasonable expectation of recovery;
– a permanent unconscious state, such as an irreversible coma or persistent vegetative state;
2. Life-sustaining treatment. I do not want my life prolonged by CPR, mechanical ventilation, dialysis or other life-sustaining treatment.
3. Artificial nutrition and hydration. I do not want artificial nutrition or hydration through a tube or IV.
4. Comfort care. I want medicine and care to relieve pain and distress, even if it may hasten my death.
5. Organ and tissue donation. I do not wish to donate my organs or tissues.
Signature: ______________________ Date: ____________
Witness 1: ______________________ Date: ____________
Witness 2: ______________________ Date: ____________
Notary (if required in Ohio): ______________________
Numbered sections: 5
Conditions covered: Terminal illness, Permanent unconsciousness
Words: 155
- Opened with your name and state and a voluntary declaration.
- Listed 2 triggering conditions, each certified by two physicians.
- Added clauses for life support, tube feeding, comfort care and organ donation.
- Closed with signature, two witness lines and a notary line.
A common choice set: no CPR or ventilator, no tube feeding, full comfort care and no organ donation, covering terminal illness and permanent unconsciousness.