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Indiana statutory health care form
Download the August 2026 Indiana Living Will Declaration packet, the form set out in Indiana Code § 16-36-4-10, for directing that dying not be artificially prolonged, with your choice on artificially supplied nutrition and hydration. Get the statutory form in editable Word and true fillable PDF. Add the completed sample PDF if you want a filled-in reference.
A state-specific living will declaration packet, reviewed against the current Indiana statute and ready for instant secure access.
Reproduces the IC 16-36-4-10 living will declaration verbatim, including all three nutrition and hydration elections, with the 2021-corrected IC 30-5-5-16 citation in the third.
Sign before two adult witnesses using the printed attestation, or use the optional notary acknowledgment added by P.L.38-2023, the form explains that either one works.
Download the files, complete them on your own device, then sign before your witnesses or notary. Your personal details are never entered into an online form builder.
This download includes 1 document in editable Word and fillable PDF formats. Use the Word version for editing; the fillable PDF can be completed on screen, then printed and signed.
Review the complete form text below before purchasing. Your licensed download (editable Word and fillable PDF) is delivered after checkout.
LIVING WILL DECLARATION
(State of Indiana — Indiana Code § 16-36-4-10)
Declaration made this ________ day of __________________________ (month, year).
I, ________________________________, being at least eighteen (18) years of age and of sound mind, willfully and voluntarily make known my desires that my dying shall not be artificially prolonged under the circumstances set forth below, and I declare:
If at any time my attending physician certifies in writing that: (1) I have an incurable injury, disease, or illness; (2) my death will occur within a short time; and (3) the use of life prolonging procedures would serve only to artificially prolong the dying process, I direct that such procedures be withheld or withdrawn, and that I be permitted to die naturally with only the performance or provision of any medical procedure or medication necessary to provide me with comfort care or to alleviate pain, and, if I have so indicated below, the provision of artificially supplied nutrition and hydration.
(Indicate your choice by initialing or making your mark before signing this declaration):
(___) I wish to receive artificially supplied nutrition and hydration, even if the effort to sustain life is futile or excessively burdensome to me.
(___) I do not wish to receive artificially supplied nutrition and hydration, if the effort to sustain life is futile or excessively burdensome to me.
(___) I intentionally make no decision concerning artificially supplied nutrition and hydration, leaving the decision to my health care representative appointed under IC 16-36-1-7 or my attorney in fact with health care powers appointed under IC 30-5-5-16.
In the absence of my ability to give directions regarding the use of life prolonging procedures, it is my intention that this declaration be honored by my family and physician as the final expression of my legal right to refuse medical or surgical treatment and accept the consequences of the refusal.
I understand the full import of this declaration.
Signed: ___________________________________________________________________________
___________________________________________________________________________________
City, County, and State of Residence
The declarant has been personally known to me, and I believe (him/her) to be of sound mind. I did not sign the declarant’s signature above for or at the direction of the declarant. I am not a parent, spouse, or child of the declarant. I am not entitled to any part of the declarant’s estate or directly financially responsible for the declarant’s medical care. I am competent and at least eighteen (18) years of age.
Witness _______________________________________ Date ___________________
Witness _______________________________________ Date ___________________
Optional notarization alternative
Publisher’s note — not part of the statutory form: Indiana law (IC 16-36-4-8(b)(5)) also lets you sign this declaration before a notary public INSTEAD of the two witnesses above. If you use a notary, leave the witness lines blank and have the notary complete the acknowledgment below.
State of Indiana, County of __________________________ — this declaration was acknowledged before me on _____________________ (date) by ______________________________ (name of declarant).
Signature of notary public: __________________________________________________________
My commission expires: _________________________ (Seal)
Legal currency, verified
This Indiana living will lets you direct that your dying not be artificially prolonged. If your attending physician certifies that you have an incurable injury, disease, or illness, that your death will occur within a short time, and that life-prolonging procedures would only artificially prolong the dying process, the declaration directs that those procedures be withheld or withdrawn so you can die naturally, with comfort care and pain relief. It is the form set out in Indiana Code § 16-36-4-10.
The statutory form was last amended in 2021 (P.L.50-2021) and is unchanged through the 2026 Indiana Code. This packet reproduces it in full — including all three artificially-supplied nutrition and hydration elections — and it was reviewed and verified against the current statute in August 2026.
You date and sign the declaration, choose whether you want artificially supplied nutrition and hydration (receive it, decline it, or leave the decision to your health care representative or attorney in fact), and have your signature witnessed. Your declaration is presumptive evidence of your wishes and must be given great weight by your physician (IC 16-36-4-8(f)). Note: under IC 16-36-4-8(d), the declaration has no effect during pregnancy.
Indiana gives you two ways to sign (IC 16-36-4-8(b)(5)): before two competent adult witnesses, or before a notary public — the notary option was added in 2023 (P.L.38-2023). The statutory witness attestation is printed in the form: witnesses must be at least 18, not your parent, spouse, or child, not entitled to any part of your estate, and not directly financially responsible for your medical care. An optional notary acknowledgment is included for the alternative path.
Your purchase includes the complete form in two formats: an editable Word (.docx) file, and a fillable PDF you can complete on screen before printing and signing.
A living will directs that dying not be prolonged. If you want the opposite — life-prolonging procedures used — Indiana publishes a companion Life Prolonging Procedures Declaration.
This form is not legal advice and does not replace the advice of an Indiana attorney about your specific situation.
ILRG is committed to top quality legal forms that are valid in all states. If you are not 100 percent satisfied after purchase, contact us for a full refund.
Yes. This packet reproduces the living will declaration form in IC 16-36-4-10, last amended in 2021 and unchanged through the 2026 Indiana Code. Reviewed and verified against the current statute in August 2026.
Either one works. Indiana law (IC 16-36-4-8(b)(5)) requires your signature in the presence of two competent adult witnesses or a notary public. The witness attestation is printed in the form, witnesses must be 18 or older, not your parent, spouse, or child, not entitled to your estate, and not financially responsible for your medical care. The notary option was added by P.L.38-2023. An optional acknowledgment block is included.
If your attending physician certifies that you have an incurable condition, death will occur within a short time, and life-prolonging procedures would only artificially prolong dying, it directs that those procedures be withheld or withdrawn so you can die naturally with comfort care. You separately choose whether to receive artificially supplied nutrition and hydration. The declaration is presumptive evidence of your wishes and must be given great weight by your physician (IC 16-36-4-8(f)).
No, under IC 16-36-4-8(d), a living will declaration has no effect during pregnancy if you have been diagnosed as pregnant by your attending physician.
Both contain the same form text. Use the editable Word (.docx) file to type in your details, or the fillable PDF to complete the form on screen. Either way, print the finished document, initial your nutrition-and-hydration election, and sign before your witnesses or notary, initials and signatures belong on paper.