New York Living Will Form (Advance Directive)

The New York living will document allows  individuals to convey end of life and health decisions in case they are at any point they are unable to, the decisions include serious illness which causes incapacitation. The form requires two witnesses. The will is created in line with US statutes  §§2964 to 2978 and §§2980 to 2994, it is not legally possible to use this directive  if the principal is found to be pregnant.

How to Write

Living Will

The principal must enter their name.


Health Care

The principal must initial any of the statements they wish to apply regarding their health care. They must cross out any they do not wish to apply.

  • Not to receive mechanical respiration.
  • Not to receive artificial hydration and nutrition.
  • Not to receive antibiotics.
  • Not to receive dialysis.
  • Not to receive blood transfusions.
  • Not to receive invasive diagnostic tests.
  • Not to receive anti psychotic medication.
  • Not to receive electric shock therapy.
  • Not to receive a transplant.
  • Not to have an abortion or be sterilized.
  • Not to receive a pacemaker (Non cardiac related terminal or irreversible condition).
  • Not to receive surgery.
  • Not to receive invasive or painful surgery.
  • To receive maximum pain relief, even if this shortens life.


Other Instructions

The principal can enter details of any other specific instructions they might have regarding their health care.

The principal must enter their details.

  • Signature.
  • Date.
  • Address.



The witnesses details must be entered.

  • Print name.
  • Signature.
  • Address.
  • Telephone number.


Organ And Tissue Donation (Optional)

The principal should state their wishes regarding an anatomical donation.

  • Initial to donate any required organs and tissues.
  • Initial and enter details of any specific anatomical donations.
  • Details any specific limitations regarding an anatomical donation.
  • Signature.
  • Date.
  • Address.