The Living Will Declaration Form serves as a crucial legal and medical document in Nigeria, despite the absence of specific living will legislation. It is primarily used when individuals wish to make their healthcare preferences known in advance of potential incapacity or end-of-life situations. The document draws its legal foundation from the Nigerian Constitution's provisions on personal rights, the National Health Act 2014, and medical ethics guidelines. It typically includes detailed instructions about life-sustaining treatments, appointment of healthcare proxies, and specific medical care preferences. While not explicitly recognized by statute, the document carries weight in medical decision-making processes and helps healthcare providers and family members understand and respect the declarant's wishes. It is particularly relevant in situations involving terminal illness, persistent vegetative states, or other conditions where the individual may become unable to communicate their healthcare preferences.
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1. Declaration and Personal Details: Opening section identifying the declarant with full name, address, date of birth, and statement of being of sound mind
2. Statement of Intent: Clear statement that this document represents the declarant's wishes regarding future medical treatment and care
3. Definitions: Definitions of key terms used in the document such as 'life-sustaining treatment', 'terminal condition', 'permanent unconsciousness', etc.
4. Healthcare Decisions: Specific instructions regarding medical treatments, life-sustaining procedures, and pain relief preferences
5. Appointment of Healthcare Proxy: Designation of a person to make healthcare decisions if the declarant becomes incapacitated
6. Revocation Clause: Statement explaining how the living will can be revoked or modified
7. Execution: Signature section including date and declarant's signature
8. Witness Attestation: Section for witnesses to sign and attest to the declarant's signature and apparent mental capacity
1. Specific Medical Conditions: Additional section for specific instructions regarding known medical conditions the declarant may have
2. Organ Donation: Optional section specifying wishes regarding organ and tissue donation
3. Religious or Cultural Preferences: Section detailing any religious or cultural considerations that should be respected in medical treatment
4. Alternate Healthcare Proxy: Designation of an alternate healthcare proxy in case the primary proxy is unavailable
5. Personal Message: Optional personal message or statement to family members and healthcare providers
1. Schedule A - Medical Treatments Checklist: Detailed checklist of specific medical treatments and procedures, indicating which are accepted or refused
2. Schedule B - Healthcare Proxy Details: Complete contact information and authority scope for designated healthcare proxy and alternates
3. Schedule C - Physician Statement: Optional form for physician's statement confirming declarant's mental capacity at time of execution
4. Appendix 1 - Glossary of Medical Terms: Detailed explanations of medical and technical terms used in the document
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