Massachusetts Living Will Form

The Massachusetts living will is a legal document that is designed to guide a user, who is of sound mind, through the process of creating a legally acceptable document stating their private wishes for medical provisions in an end of life situation. The document will alert one’s family and medical team as to exactly how they would like their treatment to be implemented. Once the Principal has completed the document, it must be signed by two witnesses to be effective. This document may be revoked or changed at any time as long as the Principal is of sound mind.


Laws – Chapter 201D et seq.

How to Write

Step 1 – Download the document and begin by reviewing “A Note About This Document,” before proceeding

Step 2 – Statement of Goals and Values (optional) –

  • If the Principal would like to make a statement with this regard, they may enter their statement into the lines provided
  • This section may be left blank as it is optional. Leaving the section blank will not invalidate the document

Step 3 – Preferences in Case of Terminal Condition –

  • If the Principal would like to select from the statements provided, initial only one.
  • If the Principal would choose not to make any selections in this section, simply cross through the entire section

Step 4 – Preference in Case of Persistent Vegetative State –

  • If the Principal would like to choose from the statements provided, initial only one.
  • If the Principal should decide against making any selections in this cross through the entire section

Step 5 – Preferences in Case of End Stage Condition –

  • Again, if the Principal would like to select a statement from this section, initial the line preceding the statement. Cross the section through, if no selections will be made
  • Read the statement under title “Pain Relief”

Step 6 – In Case of Pregnancy -If this section applies to the Principal:

  • Read the statement and respond appropriately in the lines provided

Step 7 – Effect of Stated Preferences – (required)

  • The Principal must read both statements, select and initial the one that best reflects the choice of the Principal

Step 8 – Signatures and Witnesses –  Once completed the Principal must provide

  • Principal’s (declarant’s) signature
  • Date of signature in mm/dd/yyyy

Witnesses –

  • Witnesses must read the witness statement and submit:
  • Witness signatures
  • Date of signatures in mm/dd/yyyy format
  • Phone Numbers

 

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