Indiana § 16-36-4-11 - Form of life prolonging procedures will declaration
Full text of Indiana Indiana Code § 16-36-4-11 — Form of life prolonging procedures will declaration, with citation guidance and answers to common questions.
§ 16-36-4-11. Form of life prolonging procedures will declaration
Sec. 11. The following is the life prolonging procedures will declaration form:
LIFE PROLONGING PROCEDURES DECLARATION
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 desire that if at any time I have an incurable injury, disease, or illness determined to be a terminal condition I request the use of life prolonging procedures that would extend my life. This includes appropriate nutrition and hydration, the administration of medication, and the performance of all other medical procedures necessary to extend my life, to provide comfort care, or to alleviate pain.
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 request medical or surgical treatment and accept the consequences of the request.
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 am competent and at least eighteen (18) years of age.
Witness ______________ Date ________
Witness ______________ Date ________
[Pre-1993 Recodification Citation: 16-8-11-12(c).]
As added by P.L.2-1993, SEC.19.
Source: official Indiana text · Last verified 2026-08-27
Frequently Asked Questions About Indiana § 16-36-4-11
What does Indiana Code § 16-36-4-11 cover?
Section 16-36-4-11 ("Form of life prolonging procedures will declaration") is part of the Indiana Code, the codified statutory law of Indiana. It sets out the legal rule or procedure described in the text above. Statutes are amended regularly, so always verify against the official source.
How do I cite Indiana § 16-36-4-11?
A common citation format is "Indiana Code § 16-36-4-11" (Indiana). Legal writing may require the code abbreviation, section number, and year or edition. Match the style required by your court, professor, or publisher.
Is this the official text of Indiana law?
No. This page is for research and education and may not include the most recent amendments. For official current law, check the Indiana official source linked on this page or consult a licensed Indiana attorney.
How does Indiana § 16-36-4-11 apply to my situation?
Statutes are interpreted in context, and application depends on your specific facts. Only a licensed attorney in Indiana can advise on how this section applies to you. Contact your state or local bar association for a referral.
Sources & Verification
Not legal advice. Verify against the official source and consult a licensed attorney in Indiana.