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It covers refusal of life-sustaining treatment for a life-threatening condition, permanent mental impairment, or persistent unconsciousness, plus any particular treatments or investigations the person wants to accept or refuse. The document also allows naming a relative or friend to be contacted if life is in danger and appointing a Health Care Proxy, including the proxy’s statement and required signatures.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/gibson-lane-practice-advance-directive-living-will/488901/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/gibson-lane-practice-advance-directive-living-will/488901.png","ImageObject",300,407,{"name":92,"@type":93},"Logic","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-10","2026-10-01",true,{"@type":102,"interactionType":103,"userInteractionCount":29},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What is this Living Will intended for?","Question",{"text":112,"@type":113},"It is designed to record wishes about medical treatment under specified circumstances. It cannot be used to arrange funerals or dispose of property after death.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"Which health conditions does the form address for general medical treatment refusal?",{"text":117,"@type":113},"It describes three conditions: life-threatening condition with no likelihood of recovery, permanent mental impairment with no likelihood of improvement, and persistent unconsciousness with no likelihood of regaining consciousness.",{"name":119,"@type":110,"acceptedAnswer":120},"What does the Health Care Proxy section require?",{"text":121,"@type":113},"It appoints a proxy by name and contact details and includes a statement where the proxy agrees to act and understands the role in communicating beliefs and limits on insisting on treatments.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},488901,1792833700,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":29,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":19,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":52,"preview_page_count":4},1099513958762,"https://ap-avatar.wpscdn.com/avatar/1000023916a998db790?x-image-process=image/resize,m_fixed,w_180,h_180&k=1784791008015729253","Kippax  \nLeeds LS25 7JN  \nTel:0113 2870870  \nFax:0113 2320746  \n[Email:](Email: gibsonlanepractice@nhs.net)[ ](Email: gibsonlanepractice@nhs.net)[gibsonlanepractice@nhs.net](Email: gibsonlanepractice@nhs.net)  \nVAT No: 879 1097 78  \nGibson Lane Practice  \nAdvance Directive (Living Will)  \nThe Practice wishes to assure you and your carers that under all circumstances it will strive to provide what is considered to be the best treatment for you.  \nThis Form is designed for you to record aspects of treatment that you do not wish to have under specified circumstances. If you choose not to tick any of the boxes in Section 2, your doctor will continue to provide you with any active treatment s/he feels reasonable in the specified circumstances, in consultation with your next of kin or the proxy you have nominated.  \nPLEASE NOTE: This Living Will is about medical treatment only. You cannot use it to say what is to happen after your death, or to make funeral arrangements, or to dispose of property after your death.  \n1. Statement of Beliefs  \nIf you wish to do so, please record a statement of your beliefs and values below ‐ there is no legal requirement to complete this Section.  \n2. General Medical Treatment  \nThere are three possible health conditions described below. Within each of the three you can tick the box provided to indicate your advance refusal of treatment in these circumstances.  \nPlease ensure you treat each condition separately, and it is important to note that you do not have to make the same choice for one.  \nI (Insert your name)  \nDECLARE that my medical treatment wishes are as follows:  \nLife Threatening Condition:  \nIf I have a physical illness from which there is no likelihood of recovery AND it is so serious that my life is nearing its end:  \nI do not wish to be kept alive by medical treatment. I wish medical treatment tobe limited to keeping me comfortable and free from pain, and I refuse all other medical treatment.  \nPermanent Mental Impairment:  \nIf my mental functions become permanently impaired with no likelihood of improvement; The impairment is so severe that I do not understand what is happening to me; My physical condition means that medical treatment would be needed to keep me alive:  \nI do not wish to be kept alive by medical treatment. I wish medical treatment to be limited to keeping me comfortable and free from pain and, I refuse all other medical treatment.  \nPersistent Unconsciousness:  \nIf I become persistently unconscious with no likelihood of regaining consciousness:  \nI do not wish to be kept alive by medical treatment. I wish medical treatment tobe limited to keeping me comfortable and free from pain, and I refuse all other medical treatment.  \n3. Particular treatments or investigations  \nIf you have any wishes about a particular medical treatment or test, you can record them here. If you wish to refuse a particular treatment or investigation, you should say so clearly. You should consult a doctor before writing anything in the space provided.  \nI have the following wishes about particular medical treatment or tests:  \n4. Presence of Relative or Friend  \nYou can complete this section if you would like a particular person to be with you if your life isin danger. Please note, however, that it may not be possible to contact the person you name, or for him/her to arrive in time.  \nIf my life is in danger I wish the following person to be contacted to give him/her the chance tobe with me before I die.  \n\n| Name: |  |\n| --- | --- |\n| Address: |  |\n| Contact Phone Number(s): |  |\n\nTick this box if you would like those caring for you to do their best to keep you alive for as long as is reasonable, in order to give the person you have named above a chance to see you.  \nThis instruction might mean that the doctors would need to temporarily disregard your choices in Section 2 of this form and also any refusal of particular treatment or test.  \nHealth Care Proxy  \nI appoint the following person as my H","cbCaitfUP12Ed2fj","https://ap.wps.com/l/cbCaitfUP12Ed2fj","pdf",146027,"English","# Advance Directive (Living Will)\n## Statement of Beliefs\n## General Medical Treatment\n## Particular treatments or investigations\n## Presence of Relative or Friend\n## Health Care Proxy\n## Declaration and Signatures","[{\"question\":\"What is this Living Will intended for?\",\"answer\":\"It is designed to record wishes about medical treatment under specified circumstances. It cannot be used to arrange funerals or dispose of property after death.\"},{\"question\":\"Which health conditions does the form address for general medical treatment refusal?\",\"answer\":\"It describes three conditions: life-threatening condition with no likelihood of recovery, permanent mental impairment with no likelihood of improvement, and persistent unconsciousness with no likelihood of regaining consciousness.\"},{\"question\":\"What does the Health Care Proxy section require?\",\"answer\":\"It appoints a proxy by name and contact details and includes a statement where the proxy agrees to act and understands the role in communicating beliefs and limits on insisting on treatments.\"}]","Gibson Lane Practice - Advance Directive (Living Will) | PDF",1790818843]