The Indiana Living Will elucidates one’s wishes regarding medical intervention when incapacitated and facing life-ending circumstances. Basically, the instrument comes equipped with a default clause stating that if their physician deems that death is inevitable, that there will be no medical procedures performed to prolong their life, only treatments that will provide comfort and alleviate pain. In addition, the declarant can indicate whether or not they wish to receive artificially supplied nutrition & hydration, or if they accomplished a medical power of attorney, they can stipulate that their representative make that decision for them. After stating your preferences within the form, the declarant must endorse the document while being witnessed by at least two (2) qualified individuals.
Laws
Statutes – § 16-36-4
Definition – A “living will declarant” means a person who has executed a living will declaration under Section 10 of this chapter (§ 16-36-4-3).
Signing Requirements – Must be signed in the presence of at least two (2) competent witnesses who are at least eighteen (18) years of age (§ 16-36-4-8(b)(5)).
Revocation – § 16-36-4-12
Other Versions (4)
Indiana University Health Version (also available in Spanish/en Español)
Download: Adobe PDF
Download: Adobe PDF
Download: Adobe PDF
Download: Adobe PDF, MS Word (.docx)
Additional Resources
- Indiana State Department of Health – Advance Directive Information
- Parkview Health – Living Will Information
Related Forms (6)
- Advance Directive (Medical POA & Living Will)
- DNR Order (Form 49559)
- Durable (Financial) Power of Attorney
- Life-Prolonging Procedures Declaration (Form 55315)
- Organ Donation Form
- Physician Orders for Scope of Treatment – POST (Form 55317)
Advance Directive (Medical POA & Living Will)
Download: Adobe PDF, MS Word (.docx)
DNR Order (Form 49559)
Download: Adobe PDF
Laws: § 16-36-5
Durable (Financial) Power of Attorney
Download: Adobe PDF, MS Word (.docx)
Life-Prolonging Procedures Declaration (Form 55315)
Download: Adobe PDF, MS Word (.docx)
IUH Version: Adobe PDF
Spanish Version: Adobe PDF
Laws: § 16-36-4-11
Download: Adobe PDF
Physician Orders for Scope of Treatment – POST (Form 55317)
Download: Adobe PDF, MS Word (.docx)
Laws: § 16-36-6
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