West Virginia Living Will Declaration Form

It is possible to indicate a person's desire to die naturally rather than accept life-sustaining treatment in West Virginia by executing a living will. This is only applicable if the declarant is unable to speak for themselves and is determined to be suffering from an incurable illness.

West Virginia living will template

West Virginia Living Will Declaration Form

Defining the phrase living will § 16-30-3(n)

It is possible to withhold or withdraw life-prolonging therapy in the case of a "living will," which is a recorded, witnessed advance directive signed by a person who fulfills the requirements of section 16-30-4 of this code.

Laws and statutes to adhere to for the West Virginia living will

Requirements needed to complete the signing process- Section 16-30-4(a) of the revised Code states that you must have two (2) witnesses and a notary public present while signing. •Article 30 of the Statutes (West Virginia Health Care Decisions Act)

How and what to put into writing for the West Virginia living will

West Virginia Declarant

(1) Imputing your full name - The full name of the declarant is required. 

(2) Nutritional Supplements. If you don’t want artificial feeding and or supplements that won’t cure then initial on this line.

(3) The use of artificial hydration- Add your initials if you don’t want artificial hydration.

(4) Man-made Respiration- If you do not want breathing aid in any form then initial here. 

(5) Cardiopulmonary Resuscitation (CPR)- If you don’t want your doctors and medical staff to use cardiopulmonary resuscitation then initial here. 

(6) Surgical procedures are performed. If you wish to avoid surgical procedures that won’t lead to a cure then choose this option. 

(7) Blood dialysis is an alternative for those who need it. You may choose to leave the sixth statement blank in order to enable blood dialysis to be used to treat your kidneys (if necessary). Initial the "Blood Dialysis" statement if you do not want blood dialysis supplied only for the purpose of prolonging your life after being rendered immobile by an incurable life-threatening medical ailment or a coma.

(8) Transfusion of blood. If you want to avoid blood transfusions that will only prolong your life but not cure your illness then initial next to this option. 

 (9) Prescription drugs." Initial this part if you do not want life-extending drugs that won’t cure your condition. To be clear, this does not cover prescription pain relievers. The topic of pain medication will be covered in more depth later in this essay.

10) Any kind of medical treatment you may need. Initial this statement if you don’t want a treatment that won’t cure you but will prolong your life. 

Pain Management Recommendations for Patients

(11) Treatment that has a soothing impact on the patient- You can choose to forgo pain medication that only has the purpose of maintaining life. 

Directive on Pregnancy

(12) The Effect of the Declaration- To allow this document to remain effective in the case of pregnancy, initial in Article V Section 1.

(13) Refusal to Make a Pregnancy Declaration - If you want to declare this piece of paper null and invalid for the length of your pregnancy, begin the second sentence with an asterisk before the first phrase. If you get pregnant, all of the claims made on this page will be withdrawn immediately, regardless of your medical condition or estimated life duration in the future.

Further Instructions

(14) Instructions for direct health-care delivery- Article 6 allows you to state any other medical preferences you may have.

Signature of West Virginia's Declarant

(16) Include your name, signature, and the date you signed. 

Witnesses' Statements

(16) Preparation of a statement. In order to be valid, the "Statement of Witnesses" must have the signature of the West Virginia Declarant (You).

Signature of the First Witness

(17) Requirements for the Signatures of Witnesses- The witness should be an unaffiliated adult. They should fill in their name, sign, and date. 

(18) Witness 1's Contact Information- Witness 1 must be available at some time in the near future in order for you to assert that he or she is competent to validate your signature. It is necessary to provide the location and phone number of witness 1 in order to do this.

(19) Witness Signature Requirements. The witness should write their name, sign, and date.

(20) The complete Contact Information for the 2nd Witness - By giving Witness 2 his or her address and phone number, he or she will establish himself or herself as a reputable source of signature verification.


(21) The Action of the Public Notary- The Notary Public will record the facts of your signature as well as his or her qualifications when he or she is happy with the signing procedure.

Download our free West Virginia living will in an instant to create a legally binding document.

Download our free West Virginia living will in an instant to create a legally binding document.

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