Louisiana Living Will – Free Form

As part of your Estate Planning you will want to consider a Living Will.  I have provided a free sample of a Louisiana Living Will Form below. This is very different from the Living Trust planning discussed throughout this blog, but is often part of an estate plan.  Very basically, a Living Will is your final expression of a choice to refuse medical treatment or procedures under the specific circumstances defined therein. You can direct that life sustaining procedures not be used if you so desire.  Please note the choice on withholding food and water.

These issues came to the forefront in the famous Terri Schiavo series of cases in Florida in 2005.  The political, religious and legal issues are still debated, but most states have enacted laws allowing for your expression of your choice in such a situation.  The grief and anguish that the Schiavo family went through can be avoided with proper planning. This is a very personal decision of each individual and nothing written herein is intended to influence that decision in any way.  Note that this is only a form and you may wish to consult an attorney regarding modification of the form to suit your specific situation.


 Declaration made this ____ day of ___________, 201_,

I, _____________________, being of sound mind, willfully and voluntarily make known my desire that my dying shall not be artificially prolonged under the circumstances set forth below and do hereby declare:

If at any time I should have an incurable injury, disease or illness, or be in a continual profound comatose state with no reasonable chance of recovery, certified to be a terminal and irreversible condition by two physicians who have personally examined me, one of whom shall be my attending physician, and the physicians have determined that my death will occur whether or not life-sustaining procedures are utilized and where the application of life-sustaining procedures would serve only to prolong artificially the dying process, I direct (initial one only):

___That all life sustaining procedures and hydration be withdrawn so that food and water will not be administered invasively.

___That life-sustaining procedures, except nutrition and hydration, be withheld or withdrawn so that food and water can be administered invasively.

I further direct that I be permitted to die naturally with only the administration of medication or the performance of any medical procedure deemed necessary to provide me with comfort care.

In the absence of my ability to give directions regarding the use such life-sustaining procedures, it is my intention that this declaration shall be honored by my family and physician(s) as the final expression of my legal right to refuse medical or surgical treatment and accept the consequences from such refusal.          .

I understand the full import of this declaration, and I am emotionally and mentally competent to make this declaration.

Signed:   __________________________


City of _____________, Parish of _____________, State of Louisiana.

The declarant has been personally known to me, and I believe him or her to be of sound mind.






Please feel free to use this free form if you find it helpful.  Remember to have the witnesses print their names legibly and sign above their printed name.  Also, do not forget to date the document and completely fill it and and sign it.  Witnesses must be present witnessing your signature.

DISCLAIMER:  By viewing this page or any other page or material on this website or blog, no attorney-client relationship is established.  You should always consult an attorney licensed in your state on your legal matter. Each situation involves facts and circumstances unique to you which must be considered.  The information herein is for informational and educational purposes only.  An attorney-client relationship with A. David Aymond, LLC or any member can only be established through written consent under a client engagement letter.  If you wish to discuss your situation with me I can be reached at (985) 792-5220.  Visit my website at for additional information on Estate Planning, Tax and Business law topics.



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