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Pennsylvania living will declaration
Download the August 2026 Pennsylvania Medical Directive, a standalone living-will declaration under 20 Pa.C.S. §§ 5441 through 5447, for recording treatment wishes if you cannot speak for yourself. Get the two-page form in editable legacy Word and true fillable PDF. Add the completed sample PDF if you want a filled-in reference.
A state-specific medical directive packet, reviewed against the current Pennsylvania statute and ready for instant secure access.
Record choices about resuscitation, respiration, nutrition and hydration, blood products, surgery, dialysis, antibiotics, comfort care, and other instructions.
You may name a surrogate and substitute surrogate to make treatment decisions if you become incompetent in a terminal condition or state of permanent unconsciousness.
Download the files, complete them on your own device, then print and sign before two adult witnesses. 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 two-page form text below before purchasing. Your licensed download in editable legacy Word and fillable PDF is delivered after checkout.
MEDICAL DIRECTIVE COMMONWEALTH OF PENNSYLVANIA
DECLARATION
I, ________________________________________, being of sound mind, willfully and voluntarily make this declaration to be followed if I become incompetent. This declaration reflects my firm and settled commitment to refuse life-sustaining treatment under the circumstances indicated below.
I direct my attending physician to withhold or withdraw life-sustaining treatment that serves only to prolong the process of my dying, if I should be in a terminal condition or in a state of permanent unconsciousness.
I direct that treatment be limited to measures to keep me comfortable and to relieve pain, including any pain that might occur by withholding or withdrawing life-sustaining treatment.
In addition, if I am in the condition described above, I feel especially strong about the following forms of treatment:
I do do not want cardiac resuscitation. I do do not want mechanical respiration. I do do not want tube feeding or any other artificial or invasive form of nutrition (food) or hydration (water). I do do not want blood or blood products. I do do not want any form of surgery or invasive diagnostic tests. I do do not want kidney dialysis. I do do not want antibiotics.
I realize that if I do not specifically indicate my preference regarding any of the forms of treatment listed above, I may receive that form of treatment.
Other instructions:
I do do not want to designate another person as my surrogate to make medical treatment decisions for me if I should be incompetent and in a terminal condition or in a state of permanent unconsciousness.
Name and address of surrogate (if applicable): __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________
Name and address of substitute surrogate (if surrogate designated above is unable to serve): __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________
I made this declaration on the _________ day of ____________________(month, year).
Declarant’s signature: _____________________________________
Declarant’s address: _____________________________________
_____________________________________
WITNESSES
The declarant or the person on behalf of and at the direction of the declarant knowingly and voluntarily signed this writing by signature or mark in my presence.
Witness 1’s signature: _____________________________________ Witness 1’s printed name: _____________________________________ Witness 1’s address: _____________________________________
_____________________________________
Witness 2’s signature: _____________________________________ Witness 2’s printed name: _____________________________________ Witness 2’s address: _____________________________________
_____________________________________
Legal currency, verified
This Pennsylvania medical directive is a living-will declaration that records your choices about life-sustaining treatment if you become incompetent and are in a terminal condition or a state of permanent unconsciousness. Pennsylvania permits a living will in any written form that expresses your wishes under 20 Pa.C.S. §§ 5441 through 5447.
The declaration is legally sufficient as a Pennsylvania living will under 20 Pa.C.S. Chapter 54, Subchapter B. It was reviewed against §§ 5441 through 5447 in August 2026. It is a standalone living will, not the longer combined health care power of attorney and living-will example in § 5471.
Choose your preferences for resuscitation, mechanical respiration, artificial nutrition and hydration, blood products, surgery and invasive tests, dialysis, and antibiotics. You may add other instructions and optionally designate a surrogate and substitute surrogate.
Sign the declaration and have two adults witness it under 20 Pa.C.S. § 5442. Pennsylvania does not require notarization for a living will.
Your purchase includes the two-page medical directive in legacy editable Word (.doc) format and true fillable PDF. A completed sample PDF is available separately as a filled-in reference.
To name a health care agent with broader powers and include detailed living-will instructions in one packet, use the Pennsylvania Durable Health Care Power of Attorney and Health Care Treatment Instructions, the combined example form under 20 Pa.C.S. § 5471.
This form is not legal advice. Laws change. Confirm requirements for your situation before you rely on this document.
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Yes. Pennsylvania permits a living will in any written form that expresses your wishes under 20 Pa.C.S. §§ 5441 through 5447. This declaration records treatment choices for a terminal condition or permanent unconsciousness.
Yes. Sign the declaration before two adults under 20 Pa.C.S. § 5442. The form includes separate signature blocks for both witnesses.
No. Section 5442 requires your signature and two adult witnesses, but does not require a notary for a living will.
No. This is a focused standalone living will with an optional surrogate designation. The § 5471 example is a longer combined durable health care power of attorney and living will with broader agent provisions.
Both contain the same two-page declaration. The editable Word file is in legacy .doc format. Use the fillable PDF to complete fields on screen. Print the finished document and sign it before two adult witnesses.