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Election of Treatment(s)
After you have completed this form and
printed it out, you will be allowed you to check off treatments you want
and don't want. Among those are matters which relate to treatment
while you are permanently unconscious and the condition is irreversible.
You will be given the option of receiving artificial nutrition and
hydration and other treatment. However, if you should desire any
other treatment you will be given the opportunity to write your own
directives. If you feel you may want to write additional directives,
you should discuss this with your physician before purchasing this form.
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Operative Date
A declaration becomes
operative when it is communicated to your attending physician and you are
determined by your attending physician to be in a terminal condition and
no longer able to make decisions regarding administration of
life-sustaining treatment. Your attending physician and providers of
health care must act in accordance with the provisions of your
declaration.
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Duty of
Attending Physician(s)
An attending physician or
other provider of health care who is unwilling to comply with your
declaration, shall take all reasonable steps as promptly as practicable to
transfer your care to another physician or provider of health care who
will comply.
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Revocation
You may revoke your
declaration any time and in any manner, without regard to your mental or
physical condition. A revocation is effective upon its communication
to your attending physician or other provider of health care by you or a
witness to your revocation. The revocation shall be made 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 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.
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If at any time you should have
an incurable condition certified in
writing by your attending physician and one other qualified physician to be terminal or you have been unconscious, comatose, or otherwise incompetent so as to
be unable to make or communicate responsible decisions concerning your
person, you may direct that such procedures which
would only prolong the dying process be withheld or withdrawn, and that
you be permitted to die naturally with only the administration of
medication to provide you comfort care.
