CONNECTICUT ADVANCE HEALTH-CARE DIRECTIVE

(Living Will, Appointment of Health-Care Representative & Anatomical Gift)

TABLE OF CONTENTS

I. DOCUMENT HEADER
II. DEFINITIONS
III. OPERATIVE PROVISIONS
IV. REPRESENTATIONS & WARRANTIES
V. COVENANTS & RESTRICTIONS
VI. DEFAULT & REMEDIES
VII. RISK ALLOCATION
VIII. DISPUTE RESOLUTION
IX. GENERAL PROVISIONS
X. EXECUTION BLOCK

I. DOCUMENT HEADER

1.1 Title; Parties.
 This Connecticut Advance Health-Care Directive (“Directive”) is made by [PRINCIPAL LEGAL NAME], born [DOB], residing at [ADDRESS] (the “Principal”), in favor of the health-care providers and other parties who may rely upon it, and in connection with the individuals designated herein as Health-Care Agent(s) (each, an “Agent”).

1.2 Recitals.
 A. Principal desires to make legally binding instructions regarding health-care decisions in the event of incapacity in accordance with Conn. Gen. Stat. §§ 19a-570 et seq.
 B. Principal further desires to appoint an Agent to make health-care decisions if Principal is unable, and to state wishes regarding life-sustaining treatment, pain management, and anatomical gifts.

1.3 Consideration & Effectiveness.
 The mutual promises herein constitute sufficient consideration. This Directive becomes effective as provided in § 3.6.

1.4 Governing Law.
 This Directive shall be governed by and construed in accordance with the laws of the State of Connecticut, without regard to conflict-of-laws rules.

II. DEFINITIONS

For purposes of this Directive (capitalized terms appear throughout):

“Advance Directive” means any written instruction recognized under Conn. Gen. Stat. §§ 19a-570 et seq. relating to the provision of health care when the Principal is incapacitated, including this Directive.

“Agent” means the individual designated in § 3.1 and any Alternate Agent designated in § 3.2.

“Artificial Nutrition and Hydration” means medically administered food or fluids via intravenous, gastrointestinal, nasogastric or similar routes.

“Attending Physician” means the physician having primary responsibility for the Principal’s care.

“Incapacity” means inability, as determined pursuant to § 3.6, to understand and appreciate the nature and consequences of health-care decisions and to reach and communicate an informed decision.

“Life-Sustaining Treatment” means any medical procedure, device or intervention that, when administered, serves only to prolong the dying process and where, in the reasonable medical judgment of the Attending Physician, death is imminent if the procedure is withheld or withdrawn.

“Permanent Unconscious Condition” means a condition in which reasonable medical judgment finds no reasonable expectation of regaining awareness.

“Terminal Condition” means an incurable or irreversible medical condition which will result in death within a relatively short time.

“Good Faith” has the meaning set forth in Conn. Gen. Stat. § 19a-580.

“Witness” means an individual who satisfies all requirements of § 10.3.

III. OPERATIVE PROVISIONS

3.1 Appointment of Health-Care Agent.
 Principal hereby designates [AGENT NAME], residing at [AGENT ADDRESS], telephone [PHONE], as Agent to make any and all health-care decisions for Principal that Principal could make if capable.

3.2 Alternate Agent.
 If the Agent is unable, unwilling, or unavailable, [ALTERNATE AGENT NAME], residing at [ADDRESS], telephone [PHONE], shall serve with identical authority.

3.3 Health-Care Instructions.
 A. Life-Sustaining Treatment.
  1. If I am in a Terminal Condition: [CHOOSE: Withdraw | Do Not Withdraw] Life-Sustaining Treatment.
  2. If I am in a Permanent Unconscious Condition: [CHOOSE].
 B. Artificial Nutrition and Hydration: [PROVIDE INSTRUCTION].
 C. Cardiopulmonary Resuscitation (CPR): [PROVIDE INSTRUCTION].
 D. Pain & Comfort Care: I direct maximum pain relief even if it may hasten death.
 E. Pregnancy. If I am pregnant, I understand Connecticut law may limit withdrawal of Life-Sustaining Treatment until the fetus is viable.
 F. Anatomical Gifts. Upon death I [DO | DO NOT] wish to make an anatomical gift pursuant to Conn. Gen. Stat. § 19a-289a. Specify organs/tissues: [DETAIL]; purpose(s): [TRANSPLANT | THERAPY | RESEARCH | EDUCATION].

3.4 HIPAA Authorization.
 Pursuant to 45 C.F.R. § 164.508, Principal authorizes any covered entity to disclose protected health information to the Agent to permit informed decisions.

3.5 Reliance; Directive as Certification.
 Any person, including a health-care provider or institution, may rely in Good Faith upon the representations of an Agent regarding identity, authority, and wishes of the Principal.

3.6 Determination of Incapacity & Activation.
 A. Incapacity shall be certified in writing by the Attending Physician and a second physician, or by the Attending Physician and an advanced practice registered nurse, in accordance with Conn. Gen. Stat. § 19a-580e.
 B. Upon such certification this Directive shall become operative and the Agent’s authority shall commence.

3.7 Binding Effect.
 Decisions made by an Agent pursuant to this Directive shall be binding on all persons, subject to applicable law.

IV. REPRESENTATIONS & WARRANTIES

4.1 Principal represents that:
 A. Principal is at least eighteen (18) years of age, of sound mind, and acting voluntarily.
 B. Principal has reviewed this Directive, understands its contents, and executes it free of duress or undue influence.
4.2 Each Agent, by execution of the Acceptance in § 10.4, represents that the Agent:
 A. Accepts the appointment;
 B. Will act in Good Faith and in accord with the Principal’s wishes; and
 C. Is not prohibited from serving by Conn. Gen. Stat. § 19a-571.
4.3 Survival. All representations and warranties survive the Principal’s death to the extent necessary to enforce this Directive.

V. COVENANTS & RESTRICTIONS

5.1 Principal covenants to:
 A. Provide copies of this Directive to Agent(s), health-care providers, and relevant institutions.
 B. Promptly execute revisions to maintain accuracy of information.
5.2 Agent covenants to:
 A. Consult with medical personnel and act consistently with Principal’s expressed wishes;
 B. Provide prompt notice to interested family members of significant decisions; and
 C. Keep records of material decisions when practicable.
5.3 Restrictions. Neither Agent nor Witness may derive a direct financial benefit from Principal’s death beyond ordinary intestate or testamentary succession.

VI. DEFAULT & REMEDIES

6.1 Events of Default.
 A. Provider’s willful disregard of operative instructions.
 B. Agent’s breach of fiduciary duty or actions outside scope of authority.
6.2 Notice & Cure.
 A. A non-compliant provider shall be given written notice by Agent or an interested person and a [24/48/72]-hour period to cure absent exigent circumstances.
6.3 Remedies.
 A. Injunctive relief compelling compliance with this Directive.
 B. Transfer of Principal to a willing provider at non-compliant provider’s expense if refusal persists.
 C. Reasonable attorneys’ fees and costs to prevailing party enforcing Directive.

VII. RISK ALLOCATION

7.1 Indemnification of Providers.
 Principal (and Principal’s estate) indemnifies and holds harmless any health-care provider or institution that, in Good Faith, follows this Directive or Agent’s instructions, to the fullest extent permitted by Conn. Gen. Stat. § 19a-580a.

7.2 Limitation of Liability.
 No Agent or provider acting in Good Faith shall be liable for civil damages or subject to criminal prosecution or disciplinary action for acts or omissions in reliance upon this Directive.

7.3 Insurance.
 Nothing herein requires any provider to obtain or maintain insurance; existing professional liability coverage remains applicable.

7.4 Force Majeure.
 If a public health emergency or other event of Force Majeure renders compliance impossible, providers shall act in Good Faith to approximate the Principal’s wishes as closely as circumstances permit.

VIII. DISPUTE RESOLUTION

8.1 Governing Law. Connecticut law controls all disputes.
8.2 Venue. Any action shall be brought exclusively in the Superior Court of Connecticut, [COUNTY] Judicial District.
8.3 Jury Waiver. Not applicable (see metadata).
8.4 Arbitration. Not applicable (see metadata).
8.5 Injunctive Relief. Parties acknowledge that breaches may cause irreparable harm; courts may grant equitable relief, including specific performance or injunction, in addition to any other remedies.

IX. GENERAL PROVISIONS

9.1 Amendment.
 Principal may amend this Directive in writing signed with the same formalities as execution hereof.

9.2 Revocation.
 Principal may revoke this Directive at any time by:
 A. Destroying or defacing it with intent to revoke;
 B. Executing a subsequent directive; or
 C. Orally so stating in the presence of an Attending Physician who records the revocation in the medical record.
 Revocation is effective upon the earliest occurrence of A, B, or C.

9.3 Assignment.
 Neither Agentship nor rights under this Directive may be assigned except as expressly provided in § 3.2.

9.4 Severability.
 If any provision is unenforceable, remaining provisions shall remain in full force and effect, and the unenforceable provision shall be reformed to the minimum extent necessary.

9.5 Integration; Copies.
 This Directive constitutes the entire advance directive of Principal. Photostatic or electronic copies shall have the same legal effect as originals.

9.6 Counterparts; Electronic Signatures.
 This Directive may be executed in counterparts, including electronically in compliance with Conn. Gen. Stat. § 1-267a et seq.

X. EXECUTION BLOCK

10.1 PRINCIPAL SIGNATURE

I, [PRINCIPAL NAME], execute this Directive on [DATE].

Principal Signature

10.2 STATEMENT OF WITNESSES

We declare under penalty of false statement that we are at least eighteen (18) years old, are not named as Agent or Alternate Agent, are not involved in Principal’s direct health-care, and are not entitled to any portion of the Principal’s estate except as permitted by law. The Principal appeared to be of sound mind and free from undue influence.

10.3 WITNESS REQUIREMENTS (Connecticut-Specific)

• Exactly two (2) Witnesses required.
• Neither may be the Agent, Alternate Agent, or attending health-care provider or employee thereof directly involved in Principal’s care.
• At least one Witness must not be related to Principal by blood, marriage, or adoption.

10.4 AGENT ACCEPTANCE (Optional but Recommended)

I have read this Directive, accept my appointment, and agree to act in Good Faith.

____ ____
Agent Signature & Date Alternate Agent Signature & Date

10.5 NOTARY ACKNOWLEDGMENT (Optional)

State of Connecticut  County of [COUNTY]
On [DATE], before me, [NOTARY NAME], a Notary Public, personally appeared [PRINCIPAL NAME], known to me or satisfactorily proven to be the person whose name is subscribed herein and acknowledged execution of the same for the purposes therein contained.

Notary Public
My Commission Expires: ____

[// GUIDANCE:
1. Tailor § 3.3 selections to reflect your client’s specific medical wishes.
2. Advise clients to distribute executed copies to all health-care providers and Agents.
3. Retain original in an easily accessible but secure location; do not place in a safe-deposit box only.
4. Periodically review (recommend every 3-5 years) and upon major life events (marriage, diagnosis, etc.).
5. Confirm Witness eligibility day-of-signing; if any doubt, select alternate Witnesses to avoid invalidation.
6. For hospital execution, coordinate with institutional policies; some facilities supply in-house witnesses.
7. If executing electronically, ensure compliance with Connecticut’s Uniform Electronic Transactions Act and confirm provider willingness to accept e-signatures. ]