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Oregon Advance Health Care Directive (Living Will) Form |
The Oregon Advanced Health Care Directive (Living Will) document empowers patients to legally dictate their wishes regarding medical treatment. The document is specific and comes into effect when they become ill or incapacitated. This power over their medical treatment can be through their own choices or by the principal selecting an agent to oversee their health care requirements. The document will become invalid if the principal wishes. This document requires attestation by two (2) witnesses or a notary public in accordance with ORS 127.515(2)(b), . The state of Oregon does not recognize an individual living will or power of attorney document but joins the two in a single document.
How to Write
Advance Directive
Important Information (Part A)
The principal must enter their personal details.
- Name.
- Date of birth.
- Address.
The principal must state the duration of the directive.
- Check box for the duration of the directive to be the principals entire life.
- Check box and enter the number of years for the duration of the directive.
Appointment Of Health Care Representative (Part B)
The details of any health care representatives must be entered.
- Name.
- Address.
- Telephone number.
1. Limits
The principal may enter details of any special conditions they wish to apply to their health care. They must then enter their initials.
2. Life Support
If the principal wishes to give their health care representative the power to decide if life support should be administered they should enter their initials.
3. Tube Feeding
If the principal wishes to give their health care representative the power to decide if tube feeding should be administered they should enter their initials.
The principal should confirm the appointment of a health care representative.
- Enter date.
- Enter principal`s signature.
Health Care Instructions (part C)
1. Close To Death
The principal must initial one blank field regarding their decision of they become close to death where treatment will only postpone death.
A)
- To receive a feeding tube.
- To receive a feeding tube if the physician desires this.
- Not to receive a feeding tube.
B)
- To receive any other type of life support.
- To receive life support only the physician desires.
- Not to receive life support.
2. Permanently Unconscious
The principal must initial one blank field regarding their decision of they becomes unconscious and it is unlikely that they will regain consciousness.
A)
- To receive a feeding tube.
- To receive a feeding tube if the physician desires this.
- Not to receive a feeding tube.
B)
- To receive any other type of life support.
- To receive life support only the physician desires.
- Not to receive life support.
3. Advanced Progressive Illness
The principal must initial one blank field regarding their decision of they are in advanced stages of a debilitating progressive illness and it is unlikely that they will recover.
A)
- To receive a feeding tube.
- To receive a feeding tube if the physician desires this.
- Not to receive a feeding tube.
B)
- To receive any other type of life support.
- To receive life support only the physician desires.
- Not to receive life support.
4. Extraordinary Suffering
The principal must initial one blank field regarding their decision if life support would only cause severe pain without helping their medical condition.
A)
- To receive a feeding tube.
- To receive a feeding tube if the physician desires this.
- Not to receive a feeding tube.
B)
- To receive any other type of life support.
- To receive life support only the physician desires.
- Not to receive life support.
5. General Instructions
The principal must enter their initials to refuse life support.
6. Additional Conditions And Instructions
and the details of any other conditions they require regarding their medical health care.
7. Other Documents
The patient must initial the relevant field to denote their status regarding health care power of attorney documents.
- Initial if the principal previously signed a power of attorney document and wishes it to remain unless they appoint a health care representative after signing the health care power of attorney.
- Initial if the principal has a health care power of attorney and revokes it.
- Initial if the principal does not have a health care power of attorney.
The principal must enter the date and their signature to confirm the instructions.
Declaration Of Witnesses (Part D)
The witnesses details must be entered.
- Signature.
- Printed name.
Acceptance By Health Care Representative (Part E)
The health care representative must enter their details to accept the authority.
- Signature of health care representative.
- Printed name of health care representative.
