US-CT · Customized Agreements · State-informed

Connecticut Living Will / Health Care Declaration

Locke uses the official-form living-will route for Connecticut: Document Concerning Health Care and Withholding or Withdrawal of Life Support Systems. Combined-form agent, proxy, or donation sections stay VOID in this product. This document records treatment wishes only. It does not appoint a healthcare agent and is not Connecticut MOLST.

State-informed coverageConnecticut selectedCounty nextAddress when relevant

Pinned Connecticut record · not a catalog claim

What this Connecticut instrument is

Topic	Maintained record
Instrument	Document Concerning Health Care and Withholding or Withdrawal of Life Support Systems
Route	Official or statutory form, treatment part only
Healthcare agent	Not appointed by this document. Use the separate Advance Healthcare Directive and Medical Power of Attorney.
Medical order	In Connecticut, do not represent this Living Will as the separate clinician/EMS medical-order instrument identified here. Separate instrument: Connecticut MOLST.
Execution	Sign and date in the presence of at least two witnesses. Do not use the § 19a-575a combined health-care-representative form. Comfort care remains required in all cases under § 19a-573.
Pregnancy rule	Conn. Gen. Stat. § 19a-574 (nonapplicability to a pregnant patient) was repealed effective May 24, 2018. Current § 19a-575 includes a three-way pregnancy election: (1) accept life support if it could allow a live birth, (2) apply the document unmodified, or (3) alternative instructions supplied by the maker.
Authority	Conn. Gen. Stat. § 19a-575; P.A. 18-11 pregnancy election; § 19a-574 repealed (checked 2026-08-20)

Visible coverage maturity · State-informed

What this coverage level means

Coverage area	Status	What that means
Product availability	Available	Living Will / Health Care Declaration is released for purchase and can begin with Connecticut selected.
Coverage maturity	State-informed	This document resolves maintained state-family configuration blocks. That is not a claim that every action-specific state or local rule has been reviewed.
State configuration	Maintained	living-will-health-care-declaration:healthcare_directive__CT, version 2.2.0, Healthcare Directive.
County and address	Collected when relevant	These facts narrow the document context but do not prove that every local rule has been identified.
Attorney review	Customer-arranged	Legal advice is not included; counsel of the customer's choice may review the completed document.

What Locke collects

Information that shapes this document

State, county, and address from the jurisdiction-first workflow
Legal name, current address, and signing date
Treatment elections required by the selected state's directive model
Optional values/additional instructions where the selected form allows them
Whether separate agent or clinician-order documents already exist

What this document covers

Built for the stated scope

Advance treatment planning before illness or injury
Standalone treatment instructions without appointing a healthcare agent
Coordinating written treatment wishes with an existing healthcare proxy
Recording pregnancy-related and execution rules that vary by state

Configuration record · living-will-health-care-declaration:healthcare_directive__CT · 2.2.0

How the Connecticut lane enters this draft

Locke selects this document family’s maintained state configuration after the state answer is saved. County, address, and later interview answers narrow any clauses that use those facts.

Document Concerning Health Care and Withholding or Withdrawal of Life Support Systems

DOCUMENT CONCERNING HEALTH CARE AND WITHHOLDING OR WITHDRAWAL OF LIFE SUPPORT SYSTEMS — CONNECTICUT If the time comes when I am incapacitated to the point when I can no longer actively take part in decisions for my own life, and am unable to direct my physician or advanced practice registered nurse as to my own medical care, I wish this statement to stand as a testament of my wishes. I, the information supplied in the interview, request that, if my condition is deemed terminal or if it is determined that I will be permanently unconscious, I be allowed to die and not be kept alive through life support systems. By terminal condition, I mean that I have an incurable or irreversible medical condition which, without the administration of life support systems, will, in the opinion of my attending physician or advanced practice registered nurse, result in death within a relatively short time. By permanently unconscious I mean that I am in a permanent coma or persistent vegetative state which is an irreversible condition in which I am at no time aware of myself or the environment and show no behavioral response to the environment. The life support systems which I do not want include, but are not limited to: the information supplied in the interviewArtificial respirationthe information supplied in the interview the information supplied in the interviewArtificial respiration — crossed out and initialed: I want this life support system administered.the information supplied in the interview the information supplied in the interviewCardiopulmonary resuscitationthe information supplied in the interview the information supplied in the interviewCardiopulmonary resuscitation — crossed out and initialed: I want this life support system administered.the information supplied in the interview the information supplied in the interviewArtificial means of providing nutrition and hydrationthe information supplied in the interview the information supplied in the interviewArtificial means of providing nutrition and hydration — crossed out and initialed: I want this life support system administered.the information supplied in the interview (The Connecticut statutory form directs the maker to cross out and initial life support systems the maker wants administered. Items not crossed out remain among the life support systems the maker does not want.) I do not intend any direct taking of my life, but only that my dying not be unreasonably prolonged. If I am pregnant the information supplied in the interview(1) I intend to accept life support systems if my doctor believes that doing so would allow my fetus to reach a live birth.the information supplied in the interview the information supplied in the interview(2) I intend this document to apply without modifications.the information supplied in the interview the information supplied in the interview(3) I intend this document to apply as follows: the information supplied in the interviewthe information supplied in the interview Other specific requests: the information supplied in the interview This request is made, after careful reflection, while I am of sound mind. Signature: Date: the information supplied in the interview Witnesses This document was signed in our presence, by the information supplied in the interview, who appeared to be eighteen years of age or older, of sound mind and able to understand the nature and consequences of health care decisions at the time the document was signed. Witness 1: Address: Witness 2: Address: This document is the standalone Connecticut living-will form under Conn. Gen. Stat. § 19a-575. It does not appoint a health-care representative. The combined form in § 19a-575a is a separate instrument. This Living Will is not Connecticut MOLST and does not create a clinician or EMS medical order.

Separate Medical Order — Connecticut

In Connecticut, do not represent this Living Will as the separate clinician/EMS medical-order instrument identified here. Separate medical-order instrument: Connecticut MOLST. This Living Will is not represented as that clinician/EMS medical order.

Locke is a document-assistance platform, not a law firm, and does not provide legal advice. Outputs require professional review; consult counsel of your choice.

Known coverage limit

County, municipal, court, and agency rules may still apply

Requirements may also depend on a Connecticut county, municipality, city ordinance, rent board, local court, recorder, clerk, licensing authority, zoning district, property location, or another local body. Collecting a county and address does not mean Locke has identified every applicable local rule.

Related transactions in the same state lane

Before purchase

Questions about this state-configured document

Does a Connecticut living will appoint a healthcare agent?

No. This Locke Direct product is treatment-wishes only. Agent appointment is a separate product.

Is the Connecticut living will a Connecticut MOLST?

In Connecticut, do not represent this Living Will as the separate clinician/EMS medical-order instrument identified here.

How do I sign a Connecticut living will?

Sign and date in the presence of at least two witnesses. Do not use the § 19a-575a combined health-care-representative form. Comfort care remains required in all cases under § 19a-573.

How is the Living Will / Health Care Declaration configured for Connecticut?

After you select Connecticut, Locke asks for the county and address, when relevant, and applies the maintained Connecticut configuration for this document family to your answers.

Is this a guarantee that the Living Will / Health Care Declaration will be valid?

No. Locke assists with document generation and does not guarantee legal validity, enforceability, filing acceptance, or a particular outcome.

When is payment enabled?

You can preview first. Checkout is not enabled until you affirm the required acknowledgment that Locke Direct is not a law firm and does not provide legal advice.

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