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Additional Directives
If after talking to your physicians
and family members you feel you must add other directives or specific
instructions you may do so while filling in 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)
 Your physician, health
care professional or facility or other person shall not act contrary to
your expressed intent to withhold or withdraw death-prolonging procedures
without serious reason therefor consistent with your best interest.
Such reason shall be recorded in your medical record. If an
attending physician who is unwilling to comply with your declaration he or
she
shall take all reasonable steps to effect the transfer of you to another
physician. If the policies of a health care facility preclude
compliance with your declaration that facility shall take all reasonable
steps to effect your transfer to a facility that can comply with your
declaration.
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Executing and Delivering Your Living Will
After you have signed
your document and had it witnessed by two witnesses over 18, the 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 should have a terminal condition you can express your desire that your
dying not be prolonged by administration of death-prolonging procedures.
If your condition is terminal and you are unable to participate in
decisions regarding your medical treatment, you may direct that your
attending physician withhold or withdraw necessary medical
procedures that merely prolong the dying process and are not necessary to
your comfort or to alleviate pain. The declaration for living will
provided here allows you to reduce your decision to writing.