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CONDITIONS
UNDER WHICH YOU MAY EXECUTE A LIVING WILL
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 You
may direct the withholding and
withdrawal of life-sustaining treatment and artificially provided
nutrition and hydration in the following situations:
a. If you become
terminally ill or injured to the extent that your death is imminent or
your condition, to a reasonable degree of medical certainty, is hopeless
unless you are artificially supported through the use of life-sustaining
procedures this document provides that such procedures be withheld or
withdrawn and you be permitted to die naturally with only the
administration of medication or the performance of any medical procedure
deemed necessary to provide you with comfort, care and alleviate pain.
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b. If you become
unconscious and to a reasonable degree of medical certainty 1) your
condition will last permanently, without improvement; 2) thought,
sensation, purposeful action, social interaction, and awareness of self
and environment are absent; 3) which condition has existed for a period of
time sufficient, in accordance with applicable professional standards, to
make such a diagnosis; and 4) which condition is confirmed by a physician
who is qualified and experienced in making such a diagnosis.
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ADDITIONAL INFORMATION ABOUT THIS LIVING WILL |
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Designation
of Agent
You may designate a proxy to make
health care decisions for you when you are no longer capable of making
them yourself. Your agent may consent, refuse to consent, or
withdraw consent to medical treatment and may make decisions about
withdrawing or withholding life-sustaining treatment.
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Operative Date
Your living will becomes operative when a copy is provided to
your attending physician; and you are determined by
your attending physician to be incompetent and in a terminal condition or
in a state of permanent unconsciousness.
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Revocation
You have the
right to revoke the authority granted to your agent by informing him or
her or your health care provider orally or in writing.
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 Executing and Delivering Your Living Will
After you have signed your
directive, you should gather two witnesses, over the age of 18 years, for
signing. The original or a copy should be
submitted to your physician for entry in your medical records. If you
revoke your living will, the original should be submitted to your
physician to be placed in your medical records as well.
This Advanced Health Care Directive consists
of approximately five pages.
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