LIVING WILL (ADVANCE MEDICAL DIRECTIVE)
I, Harbans Singh, son/daughter/wife of Late Sh. Gurdev Singh, aged 72 years, of House 12, Sector 40, Chandigarh, being an adult of sound mind, make this Living Will of my own free will, without pressure from anyone, at a time when I understand what I am writing.
- 1. WHEN THIS APPLIES
1.1 This Living Will applies only if I am no longer able to understand my situation or to make or tell my own medical decisions, and: If doctors certify that I have a terminal illness with no reasonable hope of recovery, or that I am in a permanent vegetative state..
1.2 While I can understand and decide, my own present wishes come first, and I may change or cancel this document at any time.
- 2. TREATMENT I REFUSE
2.1 In those situations I do not want treatment that only prolongs the process of dying. I refuse, or ask that it be withheld or withdrawn: Ventilator or breathing machine, CPR, tube feeding, dialysis, and antibiotics given only to prolong dying..
2.2 This is a request to stop or not start treatment. It is not a request for anyone to do any act to end my life.
- 3. CARE I STILL WANT
3.1 I ask that I continue to receive: Pain relief, oral care, nursing, and to be kept clean and comfortable..
- 4. MY OTHER WISHES
4.1 I wish to be cared for at home if possible, with my family beside me..
- 5. WHO SPEAKS FOR ME
5.1 If I cannot decide, I name my daughter Kiran Kaur (phone 98140 12345) as the person the doctors should speak to and who may give or refuse consent for my treatment in line with this document.
5.2 If that person cannot or will not act, I name: Rajinder Singh, son, 98150 54321.
- 6. HOW I ASK THIS TO BE FOLLOWED
6.1 I ask my family and my doctors to follow this Living Will as the law allows, and to use the hospital's medical board process that the law requires before treatment is withheld or withdrawn.
6.2 My family doctor, who should be told of this document, is: Dr. S. Gill, 98760 11122.
SIGNING
Signed at Chandigarh on 1 April 2026.
Executor: Harbans Singh
Witness 1 (name, address, signature): ____________________
Witness 2 (name, address, signature): ____________________
Attested before me (Notary Public or Gazetted Officer, name, seal and date): ____________________