Louisiana Living Will & Advance Directive for Health Care
(Comprehensive Form Compliant with Louisiana Law – Court-Ready Template)
[// GUIDANCE: This template is drafted to satisfy the Louisiana Life-Sustaining Procedures statutes and related Health-Care Decisions provisions. Customize bracketed language, remove guidance comments before final execution, and confirm conformity with the most current statutory numbering prior to client use.]
TABLE OF CONTENTS
- Document Header
- Definitions
- Operative Provisions
3.1 Statement of Intent
3.2 Conditions for Withholding or Withdrawal of Life-Sustaining Procedures
3.3 Artificial Nutrition & Hydration
3.4 Pain Management
3.5 Pregnancy Declaration
3.6 Organ & Tissue Donation - Designation of Health-Care Representative (Optional)
- Risk Allocation & Provider Protection
- Revocation Procedures
- Miscellaneous Provisions
- Execution Block
1. DOCUMENT HEADER
Louisiana Living Will and Advance Directive for Health Care
Effective Date: [EFFECTIVE DATE]
This Living Will and Advance Directive for Health Care (this “Directive”) is executed by [FULL LEGAL NAME OF DECLARANT], born [MM/DD/YYYY] (“Declarant”), a resident of the State of Louisiana, to make known Declarant’s wishes regarding medical treatment in the event Declarant becomes incapable of making such decisions. This Directive is intended to be honored in any jurisdiction wherein it is presented, to the fullest extent permitted by applicable law.
2. DEFINITIONS
For purposes of this Directive, the following capitalized terms shall have the meanings set forth below.
“Adult” means an individual who is at least eighteen (18) years of age or an emancipated minor.
“Advance Directive” or “Directive” means this legally-binding document expressing the Declarant’s health-care instructions.
“Artificial Nutrition and Hydration” means the provision of food and fluids through intravenous or enteral (e.g., gastrostomy tube) means.
“Attending Physician” means the physician who has primary responsibility for the care and treatment of the Declarant.
“Health-Care Representative” means the person designated in Section 4 to make health-care decisions on Declarant’s behalf.
“Life-Sustaining Procedure” means any medical intervention that serves only to prolong the process of dying when death is imminent, including, but not limited to, mechanical ventilation, renal dialysis, CPR, and defibrillation. It excludes procedures or medications necessary solely for comfort or pain alleviation.
“Provider” means any physician, nurse, hospital, hospice, or other health-care professional or facility acting in good faith reliance on this Directive.
3. OPERATIVE PROVISIONS
3.1 Statement of Intent
Declarant directs that, if at any time Declarant is diagnosed in writing by two (2) licensed physicians, one of whom is the Attending Physician, as having an incurable injury, disease, or illness that, in the judgment of said physicians, will result in death regardless of the application of Life-Sustaining Procedures, and Declarant is unable to communicate informed consent or dissent, then the instructions set forth herein shall govern.
3.2 Conditions for Withholding or Withdrawal of Life-Sustaining Procedures
Subject to the exceptions in Section 3.3 and Section 3.5, I hereby declare:
☐ I direct that all Life-Sustaining Procedures be withheld or withdrawn.
☐ I direct that Life-Sustaining Procedures be continued as long as medically feasible.
☐ I direct that Life-Sustaining Procedures be withheld or withdrawn except for the following:
[SPECIFY EXCEPTIONS, e.g., “transfusion” or “ventilation for reversible condition”].
[// GUIDANCE: Check only one box above and strike through unused options.]
3.3 Artificial Nutrition & Hydration
☐ I do consent to Artificial Nutrition and Hydration being withheld or withdrawn when consistent with Section 3.1.
☐ I do not consent; such measures must be continued.
3.4 Pain Management
Notwithstanding any other provision, I direct that I be provided medication or any medical procedure deemed necessary to alleviate pain or provide comfort, even if such medication or procedure may hasten the moment of death.
3.5 Pregnancy Declaration
If I am pregnant and it is determined that continuing Life-Sustaining Procedures would allow the fetus to reach live birth, I direct that my instructions (check one):
☐ Shall be given full effect without regard to pregnancy.
☐ Shall not take effect while I am pregnant, and Life-Sustaining Procedures shall be continued to sustain life until the fetus can be delivered alive.
3.6 Organ & Tissue Donation
Upon my death, and subject to medical suitability, I:
☐ Authorize organ and tissue donation for transplantation, therapy, research, or education.
☐ Do not authorize organ and tissue donation.
[Optional specific instructions: [SPECIFY OR “NONE”]]
4. DESIGNATION OF HEALTH-CARE REPRESENTATIVE (Optional)
If I am incapacitated, I designate [NAME OF REPRESENTATIVE], whose address is [ADDRESS], and whose telephone number is [PHONE], as my Health-Care Representative (“Representative”) to make health-care decisions in accordance with this Directive and Louisiana law.
Alternate Representative: [NAME / CONTACT INFO]
The Representative’s authority:
a. Commences upon certification of my incapacity by the Attending Physician;
b. Includes authority to request, consent to, or refuse treatment, including withdrawal of Life-Sustaining Procedures, consistent with this Directive;
c. Terminates upon my death unless necessary to effectuate organ donation or autopsy.
[// GUIDANCE: Louisiana permits but does not require appointment of a health-care agent. If the client already has a health-care power of attorney, avoid inconsistency.]
5. RISK ALLOCATION & PROVIDER PROTECTION
5.1 Indemnification. I agree to hold harmless and indemnify any Provider who, in good-faith reliance on this Directive, withholds, withdraws, or continues medical care, against any civil or criminal liability, save for gross negligence or willful misconduct.
5.2 Limitation of Liability. No Provider acting in good faith pursuant to this Directive shall incur liability for damages arising therefrom.
[// GUIDANCE: The foregoing tracks Louisiana’s statutory “good-faith” safe harbor while incorporating the metadata’s “good_faith_standard.”]
6. REVOCATION PROCEDURES
6.1 Right to Revoke. This Directive may be revoked by Declarant at any time, regardless of mental or physical condition, by:
a. A signed, dated writing;
b. Physical destruction or cancellation of this document by Declarant or at Declarant’s direction; or
c. An oral or other expression of intent to revoke made by Declarant to the Attending Physician or witness.
6.2 Effect of Revocation. Revocation is effective upon communication to the Attending Physician, who shall promptly enter the fact of revocation into Declarant’s medical record.
7. MISCELLANEOUS PROVISIONS
7.1 Severability. Should any portion of this Directive be adjudged invalid, the remaining provisions shall remain in full force and effect.
7.2 Governing Law. This Directive shall be governed by and construed in accordance with the health-care laws of the State of Louisiana.
7.3 Injunctive Relief. Any interested person may petition a court of competent jurisdiction for injunctive or other equitable relief to enforce the terms of this Directive.
7.4 Copies. Photostatic, electronic, or other reproduced copies of this executed Directive shall be as valid as the original.
7.5 No Waiver of Other Rights. Nothing herein shall be construed to limit my right to refuse medical treatment under any other law or doctrine.
8. EXECUTION BLOCK
I, [FULL LEGAL NAME OF DECLARANT], the Declarant herein, affirm that I am an Adult of sound mind and that I am executing this Directive voluntarily and after careful consideration.
Declarant
Signature of Declarant
Date: ___ / ___ / ______
[OPTIONAL]
Printed Name of Declarant
Witness Attestation
We declare that the Declarant signed or acknowledged this Directive in our presence, that the Declarant appears to be of sound mind and under no duress, fraud, or undue influence, and that we, the undersigned witnesses, (i) are each at least eighteen (18) years of age, (ii) are not related to the Declarant by blood or marriage, (iii) are not entitled to any portion of the Declarant’s estate, and (iv) are not the Declarant’s attending health-care providers or employees thereof.
Witness 1:
Signature
Name: [PRINTED NAME]
Address: [ADDRESS]
Date: ___ / ___ / ______
Witness 2:
Signature
Name: [PRINTED NAME]
Address: [ADDRESS]
Date: ___ / ___ / ______
[// GUIDANCE: Louisiana does not require notarization, but adding a notary block can facilitate interstate recognition.]
OPTIONAL NOTARY ACKNOWLEDGMENT
State of Louisiana
Parish of [PARISH]
On this ___ day of ____, 20__, before me, the undersigned Notary Public, personally appeared [DECLARANT NAME], known to me or satisfactorily proven to be the person whose name is subscribed herein, and acknowledged that he/she executed the same for the purposes therein contained.
Notary Public
My Commission Expires: ____
[// GUIDANCE: Provide copies to the Declarant’s physician(s), Health-Care Representative, and close family members, and upload to any state registry if applicable.]