Free New York Living Will Form

In New York, a living will form can be attached to a Medical Power of Attorney. The document ensures the fulfillment of adult residents’ wishes in case of difficult medical situations such as a coma, permanent unconscious state, or other incurable physical or mental condition and the authorization of a person they trust most to make end-of-life decisions on their behalf. As long as the living will is clear and convincing, it is acceptable and thus legal. We recommend you consult with an attorney to make sure that the document is as clear as possible.

If you consider completing the legal form, you should keep in mind that a New York Living Will can be a part of or be attached to other forms that cover similar issues with a few differences:

  • A New York (NY) Health Care Proxy grants an adult individual the right to act as an agent for another individual. While creating a New York Living Will, filling in this form is optional;
  • Advanced Healthcare Directive is a comprehensive and minute form that comprises both instructions for treatment and instructions for the authorization of an agent;
  • New York Power of Attorney is a legal form that authorizes a person to deal with financial matters on your behalf.
new york living will form

Create a free high quality New York Living Will online now!

Build Your Document

Answer a few simple questions to make your document in minutes

Save and Print

Save progress and finish on any device, download and print anytime

Sign and Use

Your valid, lawyer-approved document is ready

... or download your New York Living Will Form as a  PDF file or   Word file
Create a free high quality New York Living Will online now!

Signing Requirements and Laws

According to PHB §2981 -2994, only competent adults able to understand the document can create a New York Living Will and appoint a healthcare agent to maintain the actions set out in the living will. Medical providers consult the paper if you are not of sound mind, and there is no hope for your improvement. Even though a New York Health Care Proxy form is optional, we highly recommend appointing a representative to speak on your behalf.

As the law states, two adult and competent witnesses are to be present while signing a New York Living Will. The document is considered invalid if they do not sign the paper. The person who serves as a proxy cannot act as a witness and execute the health care proxy. Patients of facilities for people with mental disabilities are to have their doctor or another qualified psychiatrist act as a witness.

According to PHB §2981, if you consider completing a health care proxy, there are certain limitations set on a health care agent. Your doctor or any person who works at your hospital or other health care facility cannot be appointed as agents unless they are:

  • related by blood ties, marriage, or adoption;
  • doctors, nurses, or physicians assistants looking after patients of a mental hygiene facility (however, after signing the health care proxy, they cannot act as the patient’s attending practitioners).

A New York Living Will covers the following issues:

  • Life-sustaining procedure;
  • Donation of organs;
  • Additional wishes and instructions

If all the requirements listed above are met, you can proceed to create a New York Living Will.

New York Living Will Form Details

Document Name New York Living Will Form
State Form Name New York Health Care Proxy and Living Will
Signing Requirements No Statute
Validity Requirements New York Consolidated Laws, Section 2981
Powers Limitation Not specified
Avg. Time to Fill Out 13 minutes
# of Fillable Fields 48
Available Formats Adobe PDF; Microsoft Word

Template Preview
Create a free high quality New York Living Will online now!

Steps to Fill Out the Form

To create a New York Living Will and make it as clear as possible, you should take the following steps:

1. Download the Form From the Website

To start filling out the form, you are to download it from our website as a PDF file and open it in your browser or in a program that specializes in PDF files (like Adobe Reader). Once you have downloaded it, start filling it out. For more efficiency, use our convenient Online Forms Building Software to fill out the New York Living Will form.

2. Insert Your Name in the Document

Enter your full name if you give your consent to making decisions concerning life-sustaining and end-of-life treatment on your behalf if you completely lose the ability to participate in the decision-making of this kind. You agree to every directive that is specified below.
Name inserting part of New York living will form

3. Specify Your Attitude to Life Prolongation

In this part of the New York Living Will, you need to give healthcare and end-of-life instructions. You are to make a choice whether to prolong or not to prolong life. You should bear in mind that such decisions are not made on a whim. Take your time to consider all aspects thoroughly. If you think that in cases when no improvement can be expected, there is no use in extending your life, choose not to prolong it using available methods, like artificial nutrition or respiration, etc. If you want your life to be sustained as long as possible so that the treatment does not make the condition worse, choose to prolong life insisting upon following all health care standards.
Attitude to life prolongation specification section of living will for New York

4. Leave Instructions Regarding Pain Alleviation

Unless you fill in this part of the document, you will be provided with all available medicines for relief of pain even if they accelerate the process of dying. Thus, if you are aware of the risks and do not wish these pain relief methods to be applied to you, indicate it in this section.
Pain alleviation instructions part of living will template for New York

5. Add Other Instructions Regarding Medical Treatment

If you are not satisfied with the common scenarios and choices listed above, or if you want to add some directives to the instructions above, you may indicate it and write your own instructions in the section “Other Wishes”. You are allowed to specify not only your medical treatment instructions but also those concerning burial issues.
Other medical treatment instructions section of New York living will

6. Express Your Attitude to Organ Donation

There is an optional section below the previous one in which you can specify whether you wish to have organs and tissues of your own to be removed and donated. If you want to make an anatomical gift, specify what organs and tissues are to be given away. You can also limit the purpose of use by crossing out the purposes you do not agree to.
Organ donation information section of a New York living will document

7. Provide Signatures

The document needs to be signed by the declarant and two competent witnesses. If the principal has become incapable of signing themselves, the form is to be signed by someone the declarant appoints. It is mandatory to input the names, date, and addresses. The instructions and limitations for selecting witnesses are given above.
Signatures section of New York living will form

Published: May 18, 2022
Mara Erlach
Mara Erlach
Writer & Attorney
Mara has been practicing estate planning and trust law in California since 2003, taking pride in helping clients of all backgrounds and asset profiles form a complete and customized estate plan. Her specialties are: estate planning, wills and trusts, trust and probate administration.