Living Will / Advance Medical Directive

LIVING WILL / ADVANCE MEDICAL DIRECTIVE I, [declarant_name], residing at [declarant_address], being of sound mind, make this Advance Medical Directive to record my wishes regarding medical treatment should I become unable to communicate them myself, in accordance with the guidelines laid down by the Supreme Court of India in Common Cause v. Union of India. 1. TREATMENT WISHES [treatment_wishes] 2. AUTHORIZED REPRESENTATIVE I authorize [healthcare_proxy_name] to make medical decisions on my behalf, in accordance with the wishes expressed above, should I be unable to do so myself. 3. DECLARATION I make this directive voluntarily, while of sound mind, and intend for it to be honoured by my family and medical providers. Signed by me on [execution_date] in the presence of the witnesses below. [declarant_name] WITNESS 1 WITNESS 2 Name: Name: Address: Address: