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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 Physician(s)
An attending physician or health care
provider who refuses to comply with your declaration shall make the
necessary arrangements to effect your transfer to another physician who
will effectuate the provisions of you declaration of 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treatment not be withdrawn if it is possible that the embryo/fetus will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
A declaration may be
revoked at any time and in any manner by which you are able to communicate
an intent to revoke, without regard to mental or physical condition.
A revocation is only effective as to the attending physician or any health
care provider upon communication to that physician or health care provider
by you or by another who witnesses your revocation.
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Ancillary Effect of
Executing Living Will
Death resulting from the withholding or withdrawal of life-sustaining
treatment does not constitute, for any purpose, a suicide or homicide.
The making of a declaration does not affect in any manner the sale,
procurement, or issuance of any policy of life insurance, nor does it
modify the terms of an existing policy of life insurance. A policy
of life insurance is not legally impaired or invalidated in any manner by
the withholding or withdrawal of life sustaining procedures from an
insured qualified patient, notwithstanding any term of the policy to the contrary.
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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. None of the witnesses should
be a beneficiary under your last will and testament or otherwise
interested in your estate. 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.
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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.
