Example of a Living Will, plus a printable version of that Living will.

TO MY FAMILY, MY PHYSICIAN, MY CLERGYMAN, TO ANY MEDICAL FACILITY IN WHOSE CARE I HAPPEN TO BE, TO ANY INDIVIDUAL WHO MAY BECOME RESPONSIBLE FOR MY HEALTH, WELFARE OR AFFAIRS.

Be it known that I Mary L. Reed Gates of the Borough of Patton, County of Cambria and State of Pennsylvania, wish it made known that if the situation arises in which there is no reasonable expectation for recovery from physical or mental disability, I request that I be allowed to die and that I not be kept alive by artificial means or "heroic measures". Specifically I do not wish to be tube fed. I do not fear death as much as I do the indignities of deterioration, dependence and hopeless pain. I therefore request that medication be mercifully administered to alleviate suffering even though this may hasten the moment of my death.

This request is made after careful consideration. It is my wish that those caring for me feel morally bound to follow its mandate. I recognize that this places a heavy responsibility upon you, but it is my intention of relieving you of such a responsibility and of placing it upon myself in accordance with the strong conviction with which this request is made.

IN WITNESS THEREOF, I Mary L. Reed Gates, have here unto set my hand and seal this 21 April 1999.

Mary L. Reed Gates _____________________________________

Witness ________________________________________________________________

Copies of this request have been given to:

Ronald Gates, Beatrice Eckenrode, Nicole Keller, Jenard Reed