ProForma Living Will Per Florida Law

Warning: DO NOT CONSIDER USE of the living will below, or one like it, until you read this full warning explanation about its hidden dangers. There are many attorneys who have simply passed along a proforma will like the one below without really considering the risks to their clients. A signer of the form below may find they have put a kill switch in the hands of strangers who have had no prior knowledge, fidelity, or loyalty to the person signing the form.

The following legal document (name and address disguised) was what was offered to my mother for her signature by her attorney. It was fortunate that I was visiting when it arrived. When I questioned it, the lawyer stated that this was the precise wording as approved by the Florida legislature and provided him (by the bar?). He offered it to my mother with no explanations or warnings. That was left to me, her son.  I have added bold italics to aid discussion.


This Declaration is made this _____ day of __________________, 2006. I, MRS. PAPA FERVOR, willfully and voluntarily make known my desire that my dying not be artificially prolonged under the circumstances set forth below, and I do hereby declare that, if at any time I am incapacitated and as defined below:
(1) ___________ I have a Terminal Condition; or
(2) ____________ I have an End-Stage Condition; or
(3) ____________ I am in a Persistent Vegetative State

and if my attending or treating physician and another consulting physician have determined that there is no reasonable medical probability of my recovery from such condition, I direct that life-prolonging procedures be withheld or withdrawn when the application of such procedures would serve only to prolong artificially the process of dying, and that I be permitted to die naturally with only the administration of medication or the performance of any medical procedure deemed necessary to provide me with comfort care or to alleviate pain. [emphasis added]

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 such refusal. [emphasis added]

For purposes hereof:

(1) Terminal Condition means a condition caused by injury, disease, or illness from which there is no reasonable medical probability of recovery and
which, without treatment, can be expected to cause death.

(2) End-state Condition means an irreversible condition that is caused by
injury, disease, or illness which has resulted in progressively severe and permanent deterioration, and which, to a reasonable degree of medical probability, treatment of the condition would be ineffective.

(3) Persistent Vegetative State means a permanent and irreversible condition of unconsciousness in which there is:

(a) The absence of voluntary action or cognitive behavior of any kind.

(b) An inability to communicate or interact purposefully with the environment.

I understand the full import of this declaration, and I am emotionally and mentally competent to make this declaration. [emphasis added]

Additional Instructions (optional):



Print Name:
86 Down the Garden Path

Retirement City, Florida 33000
Zip Code
Print Name:




I HEREBY CERTIFY that on this day, before me, an officer duly authorized in the State and County aforesaid to take acknowledgments, the foregoing instrument was acknowledged before me by MRS. PAPA FERVOR, who is  personally known to me or  who has produced ________________________________as identification.

WITNESS my hand and official seal in the County and State last aforesaid this ______ day of ______________________, 2006.
My commission expires:

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