Life Sustaining Statute, Connecticut

Living Testament as Provided by Connecticut Statutes Section 19a-575




If the time comes when I am incapacitated to the point where I can no longer actively take part in decisions for my own life, and am unable to direct my physician as to my own medical care, I wish this statement to stand as a testament of my wishes. I _________________ request that I be allowed to die and not be kept alive through life support system if my condition is deemed terminal. I do not intend any direct taking of my life, but only that my dying not be unreasonably prolonged.


This request is made, after careful reflection, while I am of sound mind.



Signed ______________________________________________


Witness       __________________________________________________



Witness       __________________________________________________

Living Testament as Provided by Connecticut Statutes Section 19a-575

Review List

This review list is provided to inform you about this document in question and assist you in its preparation.  This simple Life Sustaining Declaration is valid in Connecticut.  Check with a local hospital or doctor’s office, as well as with an experienced medical attorney, to assure yourself of its compliance with current statute (s) in your state.


  1. Make multiple copies.  Give one to your doctor (s), the local hospital, and have others available through your attorney and family.  Remember, these kinds of documents are needed in emergency situations at worst and under stressful circumstances at best.  So be sure they are available to the appropriate people easily, when needed.


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