The Living Will Declaration Form serves as a crucial legal instrument in Belgian healthcare planning, enabling individuals to maintain autonomy over their medical care even when they become incapacitated. This document became particularly significant following the implementation of Belgium's progressive euthanasia legislation in 2002. The form allows individuals to specify their preferences for medical treatment, end-of-life care, and potential euthanasia, while also designating trusted representatives to make healthcare decisions on their behalf. Valid for five years and requiring regular renewal, this document must be properly witnessed and can be registered with relevant authorities. It provides healthcare providers with clear guidance on patient preferences and helps families avoid difficult decisions during critical situations.
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1. Personal Information: Full legal name, date of birth, national registration number, current address, and contact information of the declarant
2. Declaration of Sound Mind: Statement confirming the declarant is of sound mind and making this declaration voluntarily without any external pressure
3. General Medical Directives: Overall healthcare preferences and general principles for medical treatment in case of incapacity
4. End-of-Life Preferences: Specific instructions regarding end-of-life care, including preferences about life-sustaining treatments and euthanasia under Belgian law
5. Healthcare Representative Designation: Appointment of a trusted person to make medical decisions when the declarant becomes incapacitated
6. Physician Information: Details of the treating physician(s) and their acknowledgment of the living will
7. Execution and Witnessing: Formal signing section including date, declarant's signature, and witness attestations as required by Belgian law
1. Specific Medical Conditions: Detailed instructions for specific medical conditions the declarant currently has or anticipates
2. Organ Donation Preferences: Specific wishes regarding organ and tissue donation for transplantation or scientific research
3. Religious or Cultural Preferences: Special instructions based on religious beliefs or cultural practices that should be respected during medical care
4. Pain Management Directives: Specific preferences regarding pain management and palliative care options
5. Alternative Healthcare Representative: Designation of a secondary representative in case the primary representative is unavailable
6. Notification List: List of additional people to be notified in case of serious illness or death
1. Schedule A - Medical History: Detailed medical history including current conditions, medications, and allergies
2. Schedule B - Witness Statements: Formal statements from witnesses confirming the proper execution of the living will
3. Schedule C - Physician Acknowledgment: Official acknowledgment form signed by the treating physician
4. Schedule D - Healthcare Representative Acceptance: Formal acceptance of responsibility by the designated healthcare representative
5. Appendix 1 - Glossary of Medical Terms: Definitions of medical terms used in the living will for clarity
6. Appendix 2 - Legal Requirements Summary: Summary of Belgian legal requirements for living wills and advance directives
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