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CONDITIONS
UNDER WHICH YOU MAY EXECUTE A LIVING WILL
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 If you have a
terminal
condition you may elect that your life not be prolonged and that you do
not want any life sustaining treatment, beyond comfort care, that would
serve only to artificially delay the moment of your death.
If you have a
terminal condition or an
irreversible coma or otherwise in a
persistent vegetative state that your
doctors reasonably feel to be irreversible or incurable, you may refuse
cardiopulmonary resuscitation (the use of drugs, electric shock and
artificial breathing), artificially administered food and fluids and to be
taken to a hospital.
You may execute a living will to make clear your desire that your life BE prolonged to the greatest
extent possible.
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ADDITIONAL INFORMATION ABOUT THIS LIVING WILL |
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Adding Additional Directives
This living will allows you to
incorporate by reference other written statements of your desires.
If you talk to your physicians and family members and feel you must add
other directives, do so in your own handwriting and attach to this form.
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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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Duty of Attending
Physician(s)
When your living will becomes
operative, your physician and other health care providers shall act in
accordance with its provisions. If your attending physician or other
health care provider cannot in good conscience comply with the provisions
of your living will or if the policies of the health care provider
preclude compliance, your attending physician or health care provider
shall so inform you, or, if you are incompetent, shall so inform your
agent, or, if you have not executed a medical power of attorney, shall so inform
your family, guardian or other representative. Your physician and
health care provider shall make every reasonable effort to assist in the
your transfer to another physician or health care provider who will comply
with your living will.
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Pregnancy
Notwithstanding other
directions, if you are pregnant, you can elect that life-sustaining
treatment not be withdrawn if it is possible that the embryo/fetus will
develop to the point of live birth with the continued application of
life-sustaining treatment.
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Revocation
Your living will may be
revoked at any time and in any manner by you without regard to your
mental or physical condition. A revocation is effective upon
communication to your attending physician or other health care
provider by you or a witness to the revocation. Your attending
physician or other health care provider shall make your revocation a
part of your medical records.
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 Executing
and Delivering Your Living Will
After you have printed
out your declaration you must gather two witnesses over eighteen (18) for signing. The
executed original or copy of original should be submitted to your
physician for entry in your medical records. Copies should be made and
given to trusted family members. None of the witnesses should be a
beneficiary under your last will and testament or otherwise interested
in your estate. |
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